Management of the metabolic effects of HIV and HIV drugs

Abstract

Morphologic and metabolic abnormalities, including subcutaneous adipose tissue wasting, central adipose tissue accumulation, dyslipidemia and disorders of glucose metabolism are common among HIV-infected patients receiving highly active antiretroviral therapy (HAART) and contribute to the risk of cardiovascular disease in this population. The pathogenesis of these disorders is due to complicated interactions between effects of chronic HIV infection, HAART medications and patient factors, including genetic susceptibility. HAART has transformed HIV into a chronic condition for many patients and as a result the majority of HIV-infected patients in many areas of the developed world will soon be aged ≥50 years. Given that metabolic and cardiovascular diseases increase with aging, knowledge of the optimal management of these conditions is essential for practitioners caring for HIV-infected patients, including endocrine subspecialists. This Review highlights the clinical management of these disorders, focusing on the latest evidence regarding the efficacy of treatment strategies, newly available medications and potential interactions between HAART medications and medications used to treat metabolic disorders.

Figure 1

45-year-old HIV-infected woman with a) moderate to severe facial lipoatrophy with marked adipose tissue wasting in the malar areas with extension of adipose tissue wasting to buccal and temporal areas, and b) central lipohypertrophy with a large dorso-cervical fat pad. Permission obtained from the Endocrine Society © Brown, T. T. Approach to the human immunodeficiency virus-infected patient with lipodystrophy. J. Clin. Endocrinol. Metab. 93 (8), 2937–2945 (2008).

Figure 2

A 58-year-old HIV-infected man with severe visceral abdominal fat accumulation, umbilical hernia and diffuse subcutaneous lipoatrophy including loss of subcutaneous abdominal adipose tissue with resultant prominent appearance of veins.