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High-risk dysmetabolism disorders associated with HAART-treated HIV disease, and reimbursement of lipid-lowering drugs, in a clinical and a socio-economic perspective.

The significant advances achieved in the management of HIV disease, thanks to highly active antiretroviral therapy, are at risk of being frustrated by the recent changes in the cost reimbursement rules for all lipid-lowering drugs available in Italy. Unfortunately, the remarkably increased life expectancy achieved since mid-1996 by HIV-infected persons after the introduction of protease inhibitors and combined anti-HIV treatment, is accompanied by significant risks of developing diet-uncontrolled hypercholesterolemia and/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 lipid-lowering drugs have to take into careful consideration of this "special" category of patients (HIV-infected ones). These patients are exposed to a very frequent and severe, drug-induced dyslipidemia, and a subsequently elevated and progressively increasing cardiovascular risk, despite their proportionally lower mean age compared with that of the general at-risk population, and the lack of many concurrent risk factors which are employed to calculate the strict need for a lipid-lowering therapy, and its consequent cost reimbursement by the different health care systems.