Management of Fat Accumulation in Patients with HIV Infection

Abstract

The use of antiretroviral therapies has improved survival in people living with HIV to nearly normal rates. However, ongoing low-level HIV replication and incomplete immune recovery are associated with a chronic inflammatory stimulus. This increases several non-typically AIDS-related complications, including fat mass changes and metabolic conditions. Abdominal adiposity occurs as a result of complex interactions involving HIV itself, antiretroviral drug-associated factors, and several intermediary metabolic alterations and abnormal hormone levels. Abdominal adiposity in turn can further the metabolic derangements, and increase the risk of diabetes and cardiovascular disease. Abnormal growth hormone secretion plays a role in development of the fat depot changes. Effective long-term interventions to decrease central adiposity are limited but studies using growth hormone and especially growth hormone-releasing factor have shown encouraging results. Other emerging therapeutic options have been variably successful in the short term and the continuing clinical and therapeutic challenges will require ongoing investigation.

Impact of gender on response to highly active antiretroviral therapy in HIV-1 infected patients: a nationwide population-based cohort study

“…Since we focus on the first year after initiation of HAART only, we probably do not allow for sufficient time for this to be of clinical significance [49]. …”

Insulin resistance and adipokines serum levels in a caucasian cohort of hiv-positive patients undergoing antiretroviral therapy: a cross sectional study

“…The introduction of combination antiretroviral therapy (cART) has significantly changed the course of human immunodeficiency virus (HIV) infection, increasing life expectancy but also leading to complex clinical and metabolic changes [1]. The term lipodystrophy was initially used to summarize these clinical and metabolic modifications [2].…”

ASHP Guidelines on Pharmacist Involvement in HIV Care

“…These conditions are thought to be caused by mitochondrial toxicity and alterations in levels of growth hormone accelerated by adverse effects of antiretroviral medications, specifically protease inhibitors. 146,147 Lipodystrophy consists of an increase in visceral fat and a decrease in subcutaneous fat stores, particularly in the face and extremities. 147 Low levels of testosterone may lead to hypogonadism, sexual dysfunction, and muscle wasting in HIV-infected individuals.…”