Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

From Pathophysiology to Drug Interactions and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas

Eleni Papantoniou
,
Konstantinos Arvanitakis
ORCID logo ,
Konstantinos Markakis
,
Stavros P. Papadakos
ORCID logo ,
Olga Tsachouridou
ORCID logo ,
Djordje S. Popovic
ORCID logo ,
Theocharis Koufakis
,
Georgios Germanidis
ORCID logo ,
Kalliopi Kotsa
*
Version 1 : Received: 1 March 2024 / Approved: 1 March 2024 / Online: 4 March 2024 (10:40:30 CET)

A peer-reviewed article of this Preprint also exists.

Papantoniou, E.; Arvanitakis, K.; Markakis, K.; Papadakos, S.P.; Tsachouridou, O.; Popovic, D.S.; Germanidis, G.; Koufakis, T.; Kotsa, K. Pathophysiology and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas. Life 2024, 14, 449. Papantoniou, E.; Arvanitakis, K.; Markakis, K.; Papadakos, S.P.; Tsachouridou, O.; Popovic, D.S.; Germanidis, G.; Koufakis, T.; Kotsa, K. Pathophysiology and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas. Life 2024, 14, 449.

Abstract

Infection with human immunodeficiency virus (HIV) and induced acquired immune deficiency syndrome (AIDS) represent one of the greatest health burdens worldwide. The complex pathophysiological pathways that link highly active antiretroviral therapy (HAART) and HIV infection per se with dyslipidemia make the management of lipid disorders and the subsequent increase in cardiovascular risk essential for the treatment of people living with HIV (PLHIV). Amongst the HAART regimens, darunavir and atazanavir in terms of protease inhibitors, tenofovir disoproxil fumarate, nevirapine or rilpivirine in terms of nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors respectively, and especially integrase inhibitors, have demonstrated the most favorable lipid profile emerging as sustainable options in HAART substitution. To this day, statins remain the cornerstone pharmacotherapy for dyslipidemia in PLHIV, although important drug-drug interactions with different HAART agents should be taken into account upon treatment initiation. For those intolerant or not meeting therapeutic goals, the addition of ezetimibe, PCSK9, bempedoic acid, fibrates or fish oils should also be considered. This review summarizes the current literature on the multifactorial etiology and intricate pathophysiology of hyperlipidemia in PLHIV, with an emphasis on the role of different HAART agents, while also providing valuable insights into potential switching strategies and therapeutic options.

Keywords

HIV; dyslipidemia; metabolic syndrome; antiretroviral therapy; switching strategy

Subject

Medicine and Pharmacology, Epidemiology and Infectious Diseases

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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