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Cardiovascular risks associated with protease inhibitors for the treatment of HIV

Hatleberg, Camilla Ingrid; Ryom, Lene; Sabin, Caroline; (2021) Cardiovascular risks associated with protease inhibitors for the treatment of HIV. Expert Opinion on Drug Safety , 20 (11) pp. 1351-1366. 10.1080/14740338.2021.1935863. Green open access

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Abstract

Introduction: Cumulative use of some first-generation protease inhibitors has been associated with higher rates of dyslipidemia and increased risk of cardiovascular disease. The protease inhibitors most commonly in use are atazanavir and darunavir, which have fewer detrimental lipid effects and greater tolerability. This paper aims to review the evidence of a potential association of these contemporary protease inhibitors with the risk of ischemic CVD and atherosclerotic markers.Areas covered: We searched for publications of randomized trials and observational studies on PubMed from 1st January 2000 onwards, using search terms including: protease inhibitors; darunavir; atazanavir; cardiovascular disease; cardiovascular events; dyslipidemia; mortality; carotid intima media thickness; arterial elasticity; arterial stiffness and drug discontinuation. Ongoing studies registered on clinicaltrials.gov as well as conference abstracts from major HIV conferences from 2015-2020 were also searched.Expert opinion: Atazanavir and darunavir are no longer part of first-line HIV treatment, but continue to be recommended as alternative first line, second- and third-line regimens, as part of two drug regimens, and darunavir is used as salvage therapy. Although these drugs will likely remain in use globally for several years to come, baseline CVD risk should be considered when considering their use, especially as the population with HIV ages.

Type: Article
Title: Cardiovascular risks associated with protease inhibitors for the treatment of HIV
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1080/14740338.2021.1935863
Publisher version: https://doi.org/10.1080/14740338.2021.1935863
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: HIV, atazanavir, atherosclerotic markers, boosters, cardiovascular disease, clinical management, darunavir
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10163903
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