Impact of Combined Antiretroviral Therapy on Metabolic Syndrome Components in Adult People Living with HIV: A Literature Review

Abstract

The development of metabolic derangements as a result of HIV treatment has been an important area of research since the introduction of zidovudine in the 1980’s. Antiretroviral therapy has intensely evolved in the last three decades, with new drugs gradually incorporated into everyday clinical practice. With the life expectancy of people living with HIV rapidly approaching that of their HIV-negative counterparts, the influence of these antiretrovirals on the development of the components of the metabolic syndrome remains of major interest to clinicians and their patients. In this review, we aimed to discuss the impact of cART on components of the metabolic syndrome, i.e., weight, plasma lipid levels, plasma glucose levels, and blood pressure, describing the influence of cART classes and of individual antiretrovirals. We also aimed to outline the limitations of the research conducted to date and the remaining knowledge gaps in this area.

Spatial Heterogeneity of Brain Lipids in SIV-infected Macaques Treated with Antiretroviral Therapy

“…ART may also play a direct role in lipid dysregulation in brain as its adverse impact on metabolism is well characterized. Systemically, it is well established that ART causes a mean weight gain of 3-7 kg within the first year of initiating treatment (86)(87)(88)(89). Further, specific ART drugs or ART classes can have varying impacts on circulating lipid levels, blood pressure, and risks for developing metabolic syndromes, including diabetes mellitus.…”

“…The copyright holder for this preprint this version posted September 27, 2022. ; https://doi.org/10.1101/2022.09.26.508302 doi: bioRxiv preprint after changing regimens from older protease inhibitors (86,96). Hypertension, another disorder related to lipid dysregulation, is also more prevalent in individuals receiving ART.…”

Weight Gain and Metabolic Syndrome in Human Immunodeficiency Virus Patients

“…HIV is associated with chronic inflammation and immune activation, leading to decreased levels of total cholesterol and HDL-C and increased levels of LDL-C and triglycerides [ 23 24 ]. Dyslipidemia has been suggested to be associated with age, sex, genetic factors, and lifestyle, including diet [ 25 ].…”

“…The proportion of women enrolled in this study was too small (2.9% of the whole cohort) and it was difficult to apply the findings to newer ARTs. Hence, it was possible that the effects of weight gain on mortality, especially among women, were not examined properly [ 25 ]. Therefore, further long-term research is needed to clarify the clinical impact of ART-associated weight gain on the development of CVDs, diabetes mellitus, and mortality, especially among Korean PLWH.…”

Highly active antiretroviral therapy-silver nanoparticle conjugate interacts with neuronal and glial cells and alleviates anxiety-like behaviour in streptozotocin-induced diabetic rats

“…Consequently, the life expectancy and the quality of life among the people living with HIV have since improved ( Barbier et al, 2020 ). Despite the benefits of HAART, its long-term use and systemic exposure has been strongly linked with various metabolic disturbances such as diabetes and cardiovascular diseases ( Nansseu et al, 2018 , Sapula et al, 2022 ). Previous studies have reported that initiation of HAART increases the risk of diabetes mellitus ( Nansseu et al, 2018 , Ergin et al, 2020 ).…”