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Volume 2010 (2010), Article ID 271504, 13 pages
Review Article

Lipid Metabolism and Cardiovascular Risk in HIV-1 Infection and HAART: Present and Future Problems

11st Division of Infectious Diseases, “Luigi Sacco” Hospital, Via GB Grassi, 74, 20157 Milan, Italy
2Clinical Pharmacology Unit, “Luigi Sacco” Hospital, 20157 Milan, Italy

Received 28 April 2010; Revised 15 August 2010; Accepted 7 September 2010

Academic Editor: Gloria L. Vega

Copyright © 2010 Sara Melzi et al. 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.


Many infections favor or are directly implicated with lipid metabolism perturbations and/or increased risk of coronary heart disease (CHD). HIV itself has been shown to increase lipogenesis in the liver and to alter the lipid profile, while the presence of unsafe habits, addiction, comorbidities, and AIDS-related diseases increases substantially the risk of cardiovascular disease (CVD) in the HIV-infected population. Antiretroviral therapy reduces such stimuli but many drugs have intrinsic toxicity profiles impacting on metabolism or potential direct cardiotoxicity. In a moment when the main guidelines of HIV therapy are predating the point when to start treating, we mean to highlight the contribution of HIV-1 to lipid alteration and inflammation, the impact of antiretroviral therapy, the decisions on what drugs to use to reduce the probability of having a cardiovascular event, the increasing use of statins and fibrates in HIV-1 infected subjects, and finally the switch strategies, that balance effectiveness and toxicity to move the decision to change HIV drugs. Early treatment might reduce the negative effect of HIV on overall cardiovascular risk but may also evidence the impact of drugs, and the final balance (reduction or increase in CHD and lipid abnormalities) is not known up to date.