High-Risk Dysmetabolism Disorders Associated with HAART Treated Drugs, in a Clinical and a Socio-Economic Perspective

The significant advances achieved in the management of HIV disease, thanks to highly active antiretroviraltherapy, are at risk of being frustrated by the recent changes in the cost reimbursement rulesfor all lipid-lowering drugs available in Italy. Unfortunately, the remarkably increased life expectancyachieved since mid-1996 by HIV-infected persons after the introduction of protease inhibitors and combinedanti-HIV treatment, is accompanied by significant risks of developing diet-uncontrolled hypercholesterolemiaand/or hypertriglyceridemia, often concurrent with insulin resistance, visceral adiposity,and hypertension, all known factors which can strongly predispose to severe cardiovascular events.International and national health care system recommendations regarding the reimbursability of lipidloweringdrugs have to take into careful consideration of this “specialâ€? category of patients (HIV-infectedones). These patients are exposed to a very frequent and severe, drug-induced dyslipidemia, anda subsequently elevated and progressively increasing cardiovascular risk, despite their proportionallylower mean age compared with that of the general at-risk population, and the lack of many concurrentrisk factors which are employed to calculate the strict need for a lipid-lowering therapy, and its consequentcost reimbursement by the different health care systems.