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Resumen: Los pacientes con infección por VIH tienen una mayor incidencia de eventos cardiovasculares en comparación con la población general; los factores que contribuyen al incremento del riesgo de eventos cardiovasculares son la prevalencia de factores de riesgo cardiovascular tradicionales (FRCV), la infección por VIH que condiciona tanto un proceso de inflamación crónica como alteración de la función endotelial y la exposición a los antirretrovirales. Los factores que deben ser objeto de intervención son los FRCV tradicionales, en especial la alta tasa de fumadores entre este grupo de pacientes, la tamización y tratamiento de HTA, el síndrome metabólico y el acceso temprano a la terapia antirretroviral con medicamentos con mayor perfil de seguridad . Esta guía pretende proveer información y recomendaciones en el ámbito nacional acerca de la relación entre la infección por VIH/SIDA (Síndrome de Inmunodeficiencia Adquirida), uso de antirretrovirales y riesgo cardiovascular. Abstract: Patients with VIH infection have greater risk for cardiovascular diseases compared to general population. Risk factors that increase the frequency of cardiovascular events are: presence of cardiovascular traditional risk factors, chronic inflammation by HIV that impairs endothelial function and the exposure to antiretrovirals. The factors that should be the target for intervention are the traditional know cardiovascular factors such, especially high rate of smokers, screening and treatment for hypertension, metabolic syndrome and early access to HAART. The present guidelines provides information about the use of antiretrovirals in patients with HIV and its relation with cardiovascular risk.

RESUMEN Cuando se decide cambiar una terapia antirretroviral se puede llegar a limitar futuras opciones, y es allí donde las conductas del personal tratante deben ser las más acertadas. Se realizó un estudio transversal-descriptivo, revisando las principales causas de cambios de esquema en los pacientes VIH de la IPS CEPAIN de Bogotá (Colombia) durante el periodo 2015-2017. Los cambios de tratamiento se estimaron en 8,1%; 8,8% y 5,8% durante los 3 años, el principal motivo de cambio fueron las reacciones adversas con 53,1%; 46%, y 49,6% respectivamente, seguidos de simplificación con 17,5; 25,1 y 26,5% y fracaso terapéutico en 19,8; 20,9 y 14,8% para cada año. Durante el primer año de tratamiento existió la necesidad de cambiar los esquemas en 12,9; 18,5, y 7,6% de los pacientes que iniciaron tratamiento en esos respectivos años. Las decisiones en los cambios de tratamiento antirretroviral involucran la introducción de nuevos antirretrovirales, la necesidad de reducir el número de tabletas o medicamentos, distintos perfiles de eficacia, tolerancia, efectos secundarios, toxicidad, barrera genética e interacciones. Otros factores a tener en cuenta son: el costo creciente de los medicamentos antirretrovirales, la dinámica en la transición y aplicación de los nuevos esquemas para garantizar un enfoque clínico, y económico sustentable. SUMMARY At the time of making changes in the antiretroviral therapy, future options may be limited, and this is the time when the behavior of the treatment staff should be the most appropriate. A transversal-descriptive study was conducted, studying the main causes of scheme changes in HIV patients of the IPS CEPAIN in Bogotá (Colombia) during the 2015-2017 period. Treatment changes were estimated at 8.1%, 8.8% and 5.8% during the 3 years, the main reason for change were adverse reactions with 53.1%, 46% and 49.6% respectively, followed by simplification with 17.5, 25.1 and 26.5% and therapeutic failure in 19.8, 20.9 and 14.8% for each year. During the first year oftreatment, there was a need to change the regimens in 12.9, 18.5, and 7.6% of the patients who started treatment in those years. Decisions on antiretroviral treatment changes involve the introduction of new antiretrovirals, reduce the number of tablets or drugs, different profiles of efficacy, tolerance, side effects, toxicity, genetic barrier and interactions. Other factors to take into account are rising cost of antiretroviral drugs, the dynamics in the transition and the application of the new schemes to ensure a clinical and sustainable economic approach.

Background The use of effective antiretroviral therapy (ART) has shown to modify the trend of AIDS-defining malignancies (ADM) toward non-AIDS defining malignancies (NADM); however, Latin America is a region with a known late presentation of HIV/AIDS and late initiation of ART, which could not result in averting the incidence of ADM. The epidemiology of cancers that define or not AIDS in people living with HIV in Colombia is not known. Methods The purpose of our study was to identify the trend of ADM and NADM and the effect of ART in a collective cohort of 15 centers of 8 cities in Colombia. After the institutional review board approval, the study was conducted as a retrospective chart review of patients with any diagnosis of cancer presented after the diagnosis of HIV and a year before. Demographic and clinical data related to the HIV infection, ART treatment, and cancer diagnosis were analyzed with Stata 12 software, and associations between different variables were made using univariate and bivariate analyses. Results A total of 415 patients with malignancies were included since 1986 (table). Most common cancers were Kaposi sarcoma (n = 227; 54.7%), and non-Hodgkin lymphoma (n = 80, 19,3%). Median CD4+ cell count was very low in this population (median 115.5, P25-75 39.5–243) at the time of HIV diagnosis. Most common NADM were skin cancer (n = 22; 5.3%) and Hodgkin lymphoma (15; 3.6%). The ratio of ADM:NADM was 0.5 before 1995 and increased progressively up to 3.0 after 2010 (P = 0.001) (figure). By bivariate analysis, we found a correlation of ADM with older age (P < 0.001), male gender (P = 0.03), recent years (P < 0.001), lower CD4 and higher VL at the time of cancer (P < 0.0001 for both), and mortality (P = 0.027). Cancer-associated mortality was 3.9%. Conclusion The trend for diagnosis of ADM in Colombia is increasing despite antiretroviral treatment and exceeds NADM diagnosis. Potential explaining factors are the late presentation and initiation of ART, and poor treatment success in this population. Special efforts are required to diagnose and treat HIV patients in Colombia to avert this worrying trend. Disclosures All authors: No reported disclosures.