目的:这份共识文件是针对HIV感染患者的代谢紊乱和心血管风险(CVR)指南的更新。
方法:本文件已由GEAM专家小组批准,SPNS和GESIDA在回顾了临床试验的有效性和安全性结果后,队列和药代动力学研究发表在生物医学杂志(PubMed和Embase)或在医学科学会议上发表。建议强度和支持它们的证据基于等级系统。
结果:建议健康的生活方式,不吸烟,每天至少有氧运动30min。在糖尿病患者中,推荐与非HIV感染患者相同的治疗方法。合并血脂异常的HIV患者应考虑为高CVR,因此其治疗目标是LDL小于100mg/dL。ACE抑制剂和ARAII家族的抗高血压耐受性更好,相互作用的风险较低。在患有糖尿病或代谢综合征且转氨酶升高且无明确病因的HIV患者中,建议排除肝性脂肪变性也更新了对激素改变的作用建议.
结论:这些新指南更新了以前关于所有与CVR有关的代谢紊乱的建议。还包括激素变化及其管理以及代谢紊乱对肝脏的影响。
OBJECTIVE: This
consensus document is an update of metabolic disorders and cardiovascular risk (CVR)
guidelines for HIV-infected patients.
METHODS: This document has been approved by an expert panel of GEAM, SPNS and GESIDA after reviewing the results of efficacy and safety of clinical trials, cohort and pharmacokinetic studies published in biomedical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendation strength and the evidence in which they are supported are based on the GRADE system.
RESULTS: A healthy lifestyle is recommended, no smoking and at least 30min of aerobic exercise daily. In diabetic patients the same treatment as non-HIV infected patients is recommended. HIV patients with dyslipidemia should be considered as high CVR, thus its therapeutic objective is an LDL less than 100mg/dL. The antihypertensive of ACE inhibitors and ARAII families are better tolerated and have a lower risk of interactions. In HIV-patients with diabetes or metabolic syndrome and elevated transaminases with no defined etiology, the recommended is to rule out a hepatic steatosis Recommendations for action in hormone alterations are also updated.
CONCLUSIONS: These new
guidelines update previous recommendations regarding all those metabolic disorders involved in CVR. Hormone changes and their management and the impact of metabolic disorders on the liver are also included.