58
Special Populations
6.8. HIV and Autoimmune Disorders
COR LOE Recommendations
HIV
1 B-R 1. In adults with CCD and HIV, antiretroviral therapy is
beneficial to decrease the risk of cardiovascular events.
2a B-R 2. In adults with CCD and HIV, it is reasonable to choose
antiretroviral therapy regimens associated with more favorable
lipid and cardiovascular risk profiles with consideration of
drug-drug interactions.
3: Harm C-LD 3. In adults with CCD and HIV, lovastatin or simvastatin should
not be administered with protease inhibitors as this may cause
harm.
Autoimmune Disorders in CCD
2a C-LD 4. In adults with CCD and rheumatoid arthritis, initiation and
maintenance of disease modifying anti-rheumatoid drugs is
beneficial to decrease the risk of cardiovascular events.
2b C-LD 5. In adults with CCD and autoimmune diseases, treatment
with biologics and other immune modulating therapies that
reduce disease activity may be considered to decrease the risk of
cardiovascular events.
3: Harm C-LD 6. In patients with CCD and rheumatoid arthritis, high-dose
glucocorticoids should not be used long term if alternative
therapies are available because of increased cardiovascular risk.
Table 23. Common Antiretroviral Therapy Drugs and Effects
on Lipid Levels
Class Drug Effect on Blood Lipids
Protease
inhibitors
Atazanavir Increases HDL-C and decreases LDL-C levels
Darunavir Increases HDL-C levels
Fosamprenavir Hypertriglyceridemia
Ritonavir* Increases HDL-C levels
Saquinavir Neutral
Tipranavir Dyslipidemia
6.7. Chronic Kidney Disease
COR LOE Recommendation
1 C-LD 1. In patients with CCD and CKD, measures should be taken to
minimize the risk of treatment-related acute kidney injury.*
* Modified from the 2021 ACC/AHA/SCAI guideline for coronary artery revascularization. Lawton
JS, et al. op. cit.
