HIV와 HAART 요법과 관련된 대사합병증: 개요 및 임상증례보고

Metabolic Complications Associated with HIV and Highly Active Antiretroviral Therapy : Overview & A Clinical Case Report

  • 최은주 (조선대학교 약학대학 & 임상약학대학원) ;
  • 투고 : 2012.08.24
  • 심사 : 2012.09.17
  • 발행 : 2012.09.30

초록

현재 HIV(human immunodeficiency virus) 감염에 대하여 보다 많은 효과적인 약물치료법이 가능하다. Highly active antiretroviral therapy (HAART)로 언급되는 이 치료법은 항 HIV치료제의 다양한 병용법으로 구성된다. 그러나, 최근에 이렇게 치료된 환자들에게 중요한 독성들(toxicities)로서 빈번하게 상당한 지질이상과 혈중당의 항상성 조절장애와 연관된 몸의 지방 분포 비정상으로서 나타나는, 광범위한 대사성 합병증(metabolic complications)이 출현해왔다. 이러한 합병증의 관리는 표준적인 치료 중재(interventions)와 연관하여 지질과 당 대사와 관련된 항 HIV치료제의 특성 있는 효과를 이해하면서, 항 HIV 약물들을 조절하는 것을 포함한다. 본 증례는 항HIV 약물요법과정에서 나타난 상당한 지질 이상, 매우 높은 LDL 수치와 높은 TG수치에 따르는 후속 약물요법을 보여주며, 개별화된 항 HIV 약물요법을 수행하면서, 대사성 합병증에 관련된 수치의 검사와 주기적인 약물치료과정의 모니터링을 권하여 HIV에 감염된 환자들의 효과적인 치료를 향상시키기 위한 것이다.

키워드

참고문헌

  1. Guidelines for the Use of Antiretroviral Agents in HIV-1- Infected Adults and Adolescents, Available at http://www. aidsinfo.nih.gov/ContentFiles/Adultan-dAdolescentGL.pdf/. Assessed on Jun 20, 2012.
  2. Julian Falutz. Therapy Insight: body-shape changes and metabolic complications associated with HIV and highly active antiretroviral therapy. NATURE CLINICAL PRACTICE ENDOCRINOLOGY & METABOLISM 2007; 3(9): 651-662. https://doi.org/10.1038/ncpendmet0587
  3. Bozzette SA., Ake CF, Tam HK, et al. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. The New England Journal of Medicine 2003; 348(8): 702-710. https://doi.org/10.1056/NEJMoa022048
  4. Palella FJ, Delaney KM, Moorman AC et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. The New England Journal of Medicine 1998; 338(13): 853-860. https://doi.org/10.1056/NEJM199803263381301
  5. Van Wijk JP and Cabezas MC. Hypertriglyceridemia, Metabolic Syndrome, and Cardiovascular Disease in HIVInfected Patients: Effects of Antiretroviral Therapy and Adipose Tissue Distribution. International Journal of Vascular Medicine 2011; 2012: 1-13. doi:10.1155/2012/ 201027.
  6. Carr A et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998 12: F51-F58. https://doi.org/10.1097/00002030-199807000-00003
  7. Currier JS. How to manage metabolic complications of HIV therapy: what to do while we wait for answers. AIDS Read 2000; 10: 162-169.
  8. Lee D, Mathews WC.Prevalence and risk factors for hyperglycemia, dyslipidemia, and coronary disease among HIV-infected patients on initial protease inhibitor therapy [abstract 644]. In: 6th Conference on Retroviruses and Opportunistic Infections: program and abstracts (Chicago, 31 January to 4 February 1999). Available at http:// www.retroconference.org/99/default.htm.
  9. Murillas J, Martin T, Ramos A, Portero JL. Atorvastatin for protease inhibitor-related hyperlipidaemia. AIDS 1999; 13: 1424-1425. https://doi.org/10.1097/00002030-199907300-00030
  10. Sullivan AK, Nelson MR. Marked hyperlipidaemia on ritonavir therapy. AIDS 1997; 11: 938-939.
  11. Sullivan AK, Feher MD, Nelson MR, Gazzard BG. Marked hypertriglyceridaemia associated with ritonavir therapy. AIDS 1998; 12: 1393-1394. https://doi.org/10.1097/00002030-199811000-00024
  12. Smith KY. Selected Metabolic and Morphologic Complications Associated with Highly Active Antiretroviral Therapy. The Journal of Infectious Diseases 2002; 185 (Supp2): S123-S127. https://doi.org/10.1086/340200
  13. Wohl DA, McComsey G, Tebas P et al. Current concepts in the diagnosis and management of metabolic complications of HIV infection and its therapy. Clin Infect Dis 2006; 43: 645-653. https://doi.org/10.1086/507333
  14. Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med 2005; 352: 48-62. https://doi.org/10.1056/NEJMra041811
  15. Lundgren JD, Battegay M, Behrens G, et al. European AIDS Clinical Society(EACS) guidelines on the prevention and management of metabolic disease in HIV. HIV Medcine 2008; 9: 72-81. https://doi.org/10.1111/j.1468-1293.2007.00534.x
  16. HIV InSite. ARV Charts and Tables. Available at: http:// hivinsite.ucsf.edu/insite Assessed on Jul 27, 2012.
  17. Nevirapine ($Viramune^{(R)}$) Clinical Pharmacology, Available at http://www.clinicalpharmacology-ip.com.ezproxylocal.library.nova.edu/Form/. Assessed on Jul 28, 2012.
  18. Nelfinavir, ($Viramune^{(R)}$) Clinical Pharmacology, Available at http://www.clinicalpharmacology-ip.com.ezproxylocal. library.nova.edu/Form/. Assessed on Jul 28, 2012.
  19. Tenofovir, Emtricitabine ($Truvada^{(R)}$) Clinical Pharmacology, Available at http://www.clinicalpharmacology-ip.com. ezproxylocal.library.nova.edu/Form/. Assessed on Jul 28, 2012.
  20. Lopinavir / ritonavir ($Kaletra^{(R)}$) Clinical Pharmacology, Available at http://www.clinicalpharmacology-ip.com. ezproxylocal.library.nova.edu/Form/. Assessed on Jul 28, 2012.
  21. Law MG, Friis-Moller N, El-Sadr WM et al. The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D study. HIV Med 2006; 7: 218-230. https://doi.org/10.1111/j.1468-1293.2006.00362.x
  22. Singh S, Willig JH, Mugavero MJ et al. Comparative Effectiveness and Toxicity of Statins Among HIV-Infected Patients. Clinical Infectious Diseases 2011; 52(3): 387-395. https://doi.org/10.1093/cid/ciq111
  23. Abacarvir/lamivudine ($EPZICOM^{(R)}$) Clinical Pharmacology, Available at http://www.clinicalpharmacology-ip.com. ezproxylocal.library.nova.edu/Form/. Assessed on Jul 28, 2012.
  24. Atazanavir($Reyataz^{(R)}$) Clinical Pharmacology, Available at http://www.clinicalpharmacology-ip.com.ezproxylocal. library.nova.edu/Form/. Assessed on Jul 28, 2012.
  25. Yeo JY, Shin HS, Chin BS, et al. Factors Associated with Renal Dysfunction, Including Highly Active Antiretroviral Therapy in Korean HIV-Infected Patient. Korean Journal of Clinical Pharmacy. 2012; 22(2): 95-102.