Foreword to the First Edition
Never in the history of humanity has knowledge progressed as quickly as in the field of AIDS. Over a period of 15 years, successive discoveries of the disease, its viral origin, the virus responsible, its physiopathology and highly effective therapies have led to spectacular improvement in life expectancy and in the quality of life of people who have access to these treatments.
However, this progress in therapy has been accompanied by initially unforeseeable anomalies, such as abnormalities in lipid and glucose metabolism and modifications in fat distribution, particularly in perivisceral and trunkal accumulation as well as pseudo-obesity usually accompanied by peripheral atrophy.
Several of these anomalies constitute risk factors for cardiovascular diseases and may be predictors of these diseases. Over time, most investigators have come to accept that HIV- infected patients are at an increased risk for cardiovascular complications.
However, several issues remain unclear:
• Does the increased risk merely reflect modification of the usual factors: metabolic disorders, tobacco consumption, infectious context related to HIV infection or opportunistic infections, inappropriate immune and cytokine response, or genetic background?
• The physiopathology of disorders in glucose or lipid metabolism remains to be clarified. It is unclear whether they result from treatment, use of a specific medication, use of a therapeutic class of medication, or an association of treatments. Here, too, genetic background may well be a factor, along with the history of the individual’s HIV infection.
It is particularly difficult to devise a therapeutic strategy under these conditions, especially since the efficacy of the usual lipid- or glucose-modifying medication is not established, and the benefit of any eventual correction of such biological anomalies in this population is unclear.
The issue is further complicated by the many drug interactions between antiretroviral medications and medications likely to act on the lipid metabolism, which renders their usage complex.In this atmosphere of uncertainty, the simple measure of
diminishing tobacco usage is itself difficult, and overconsumption of tobacco is regularly observed in this population.
The medical management of HIV-infected patients is mostly carried out by infectious disease specialists, and the field of cardiovascular diseases is not usually familiar to them.
The history of AIDS has taught us that phenomena are most quickly and effectively understood when light is cast on them from a variety of angles, using a variety of tools. The dynamism which has always characterized AIDS research will doubtless benefit from greater comprehension of the mechanisms of these poorly understood metabolic disorders.
The present volume contributes to disseminating knowledge in the field so that the various actors can pool their expertise towards a successful management of cardiovascular disease in HIV-infected patients.
Willy Rozenbaum, MD Professor of Infectious Diseases Universite Pierre et Marie Curie Paris, France