Strategies for choice of antiretroviral therapy in patients with HIV infection and concomitant cardiovascular disease: A review

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Abstract

HIV infection is associated with an increased risk of cardiovascular and kidney disease. Comorbidity is gradually becoming one of the main drivers for premature mortality in HIV patients: in Russia, from 2007 to 2022, mortality rates in HIV patients not related to opportunistic infections increased more than twofold. People living with HIV have all the common cardiovascular risk factors, moreover, special attention should be paid to kidney function, since its impact on cardiovascular disease (CVD) risk is frequently underestimated. In the current document, approaches to selection of antiretroviral therapy (ART) are reviewed in the context of HIV patients with concomitant CVD/high cardiovascular risk. Main factors of ART choice were analyzed for regimens based on 2nd generation integrase strand transfer inhibitors dolutegravir/bictegravir and non-nucleoside reverse transcriptase inhibitor doravirine, which are included in the national and main international clinical guidelines and are available in the Russian Federation. A detailed review of the ART selection criteria includes effectiveness of contemporary antiretrovirals in high viral load, poor cell immunity, expected patients’ adherence, drug resistance profile, along with comorbidities such as CVD, excess body weight, and kidney disease. In addition, topics related to interdisciplinary interaction between infectious disease, cardiology/internal medicine specialist in context of people living with HIV with concomitant CVD are also covered in the paper.

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About the authors

Vasily I. Shakhgildyan

Central Research Institute for Epidemiology

Author for correspondence.
Email: vishakh@yandex.ru
ORCID iD: 0000-0002-8686-0487

кандидат медицинских наук, старший научный сотрудник Специализированного научно-исследовательского отд. по профилактике и борьбе со СПИДом

Russian Federation, Moscow

Simon T. Matskeplishvili

Lomonosov Moscow State University

Email: vishakh@yandex.ru
ORCID iD: 0000-0002-5670-167X

чл.-кор. РАН, д-р мед. наук, профессор, рук. отд. кардиологии и сердечно-сосудистой хирургии Медицинского научно-образовательного института

Russian Federation, Moscow

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