Pai Ching Yu

Cardiovascular manifestations in patients infected with the human immunodeficiency virus

Today, it is estimated that the infection caused by the human immunodeficiency virus affects 42 million people worldwide. In Brazil 1,200,000 individuals are infected, and 257,780 of them have the Acquired Immunodeficiency Syndrome (AIDS). AIDS currently accounts for 1.41% of reported deaths in Brazil, a number that is decreasing owing to the national antiretroviral treatment distribution policy, which provides HIV-infected individuals universal access to available therapy.

Terapia hipolipemiante em situações especiais: síndrome de imunodeficiência adquirida

Lipid alterations can be observed early among patients with AIDS disease. Commonly, these lipid abnormalities include low HDL-C and modest increase in triglyceride plasma levels. Highly Active Anti-Retroviral Therapy (HAART) in these patients may aggravate the dyslipidemia, with notable increases in triglycerides as well as in LDL-C. There are several mechanisms proposed to explain the mixed hyperlipidemia observed in these subjects, including different steps in lipid metabolism. The importance of the treatment of dyslipidemia became evident with the increased life expectancy and reports of cardiovascular complications in these individuals. There is an insulin resistance state in patients with AIDS disease under treatment with HAART, who present with lipodystrophy, hypertriglyceridemia, low levels of HDL-C. Antiretroviral drugs are metabolized by CYP P450 3A4 and interactions with some statins, especially with simvastatin are expected to occur. Treatment with lipid-lowering agents should be based on lipid profile and coronary risk. For hypertriglyceridemias, fibrates (mainly fenofibrate or bezafibrate) should be the drugs of choice, as well as statins (mainly pravastatin). Combined treatment using fibrates plus statins are recommended for severe mixed hyperlipidemias under very close monitoring for adverse effects.

Perioperative myocardial infarction has been forgotten.

Thygesen et al. ([1][1]) have published a consensus report that reviews the definition of myocardial infarction (MI) and proposes a new classification of 5 categories based on differences in pathophysiology. We believe that this definition is flawed in 1 respect: it does not mention perioperative MI