HIV and Highly Active Antiretroviral Therapy: Dyslipidemia, Metabolic Aberrations, and Cardiovascular Risk

Relationship of Postprandial Nonesterified Fatty Acids, Adipokines, and Insulin Across Gender in Human Immunodeficiency Virus–Positive Patients Undergoing Highly Active Antiretroviral Therapy

“…Our fi ndings are in agreement with the notion that HIV/HAART is associated with metabolic disorders and dyslipidemia, similar to those of metabolic syndrome, such as lipodystrophy, dyslipidemia (hypertriglyceridemia, decreased HDL-C, and increased free fatty acids) and insulin resistance. 10,28 Studies in HIV-positive subjects demonstrated that inhibition of lipolysis by acipimox resulted in a signifi cant reduction in lipolysis and NEFA levels. 29 Furthermore, a recent study using a high-fat meal showed that increased postprandial NEFA levels were associated with insulin resistance (HOMA-IR) and lipoatrophy in HIV-positive subjects.…”

Enfermedad cardiovascular y metabólica en pacientes infectados por el virus de la inmunodeficiencia humana

“…Los mecanismos que han intentado explicar este fenómeno incluyen incremento en los niveles de citoquinas (TNF e IL-6), disminución de la depuración de los lípidos, y el aumento de la síntesis hepática de lipoproteína de muy baja densidad 65 . Diversos estudios han demostrado que existe un riesgo significativamente mayor de presentar dislipidemia en pacientes con VIH expuestos a tratamiento antirretroviral en comparación a quienes no lo recibieron, manifestada por lo general como disminución de HDL-c, aumento de LDL-c y aumento de colesterol total, un perfil lipídico similar al que se presenta en pacientes con síndrome metabólico 14,65,67 . Dentro de los diferentes regímenes antirretrovirales, la dislipidemia se asocia en un 70% los que incluyen los inhibidores de la proteasa, igualmente se relacionan con obesidad central, lipodistrofia y resistencia a la insulina 65 .…”

“…La intolerancia a la glucosa se estima que está presente en cerca del 35% de los sujetos infectados por el VIH en comparación con el 5% de los sujetos de control sanos 14,69 . Se estima que riesgo de desarrollar diabetes mellitus tipo 2 es 3,1 veces mayor en pacientes con VIH que reciben TAR en comparación con sujetos sin tratamiento 70 .…”

Metabolic Abnormalities in HIV-Infected Populations without or with Antiretroviral Therapy (ART)

“…These agents improved quality of life and longevity in individuals with HIV by significantly lowering mortality and morbidity rates. Of the six antiretroviral drug classes, the metabolic side effects of ART are most frequently detected with PIs, followed by NRTIs, and NNRTIs that have different and specific effects [69,70]. In spite of all of the remarkable properties of antiretroviral medications, some chronic conditions such as dyslipidemia, disturbances in glucose homeostasis, IR, and hyperinsulinemia have been documented as the direct adverse effects of ART or as a result of combination with other risk factors such as HIV itself, an unhealthy lifestyle, and environmental factors [1,67,68].…”