Cardiovascular risk management in human immunodeficiency virus (HIV)-infected individuals is gaining increased attention due to the rising incidence and prevalence of cardiovascular disease in this population. Despite the availability of efficacious treatment strategies, implementation of guideline advocated preventive therapy, such as lipid-lowering therapy with statins, is hampered by perceived, expected, and real side effects as well as by expected interactions with combination antiretroviral therapy. These obstacles to optimal treatment have resulted in a large gap between the number of patients in whom lipid-lowering therapy is indicated and those actually taking lipid-lowering medication. In the past few years, research has shown that the majority of patient-reported side effects is not causally related to statin therapy but is attributable to the nocebo effect. Furthermore, excessive caution due to expected drug interactions between statins and antiretroviral therapy is often unnecessary, especially with novel classes of antiretroviral therapy. The main aim of this review is to discuss the causes and consequences of this lipid-lowering treatment gap in HIV-infected patients together with a practical guide on how to overcome these obstacles. In addition, new treatment options on the optimal cardiovascular management focusing primarily on novel classes of antiretroviral therapy and lipid-lowering medication will be discussed.

中文翻译：

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克服艾滋病毒患者降脂治疗的障碍-当前证据的系统评价。

由于该人群中心血管疾病的发病率和患病率不断上升，人类免疫缺陷病毒（HIV）感染者的心血管风险管理越来越受到关注。尽管有有效的治疗策略，但指导性主张的预防性治疗（例如他汀类降脂治疗）的实施受到感知，预期和实际副作用以及与抗逆转录病毒疗法联合使用的预期相互作用的阻碍。这些阻碍最佳治疗的障碍导致了需要进行降脂治疗的患者与实际服用降脂药物的患者之间存在巨大差距。在过去的几年里，研究表明，大多数患者报告的副作用与他汀类药物治疗无因果关系，而归因于Nocebo效应。此外，由于他汀类药物与抗逆转录病毒疗法之间预期的药物相互作用而导致的过度谨慎通常是不必要的，尤其是对于新型抗逆转录病毒疗法而言。这篇综述的主要目的是讨论在HIV感染患者中降低脂质治疗差距的原因和后果，以及有关如何克服这些障碍的实用指南。此外，将讨论主要针对新型抗逆转录病毒疗法和降脂药物的最佳心血管管理的新治疗方案。由于他汀类药物与抗逆转录病毒疗法之间可能存在药物相互作用，因此通常不必过度谨慎，尤其是对于新型抗逆转录病毒疗法。这篇综述的主要目的是讨论在HIV感染患者中降低脂质治疗差距的原因和后果，以及有关如何克服这些障碍的实用指南。此外，还将讨论主要针对新型抗逆转录病毒疗法和降脂药物的最佳心血管管理的新治疗方案。由于他汀类药物与抗逆转录病毒疗法之间可能存在药物相互作用，因此通常不必过度谨慎，尤其是对于新型抗逆转录病毒疗法。这篇综述的主要目的是讨论在HIV感染患者中降低脂质治疗差距的原因和后果，以及有关如何克服这些障碍的实用指南。此外，将讨论主要针对新型抗逆转录病毒疗法和降脂药物的最佳心血管管理的新治疗方案。