How to manage metabolic complications of HIV therapy: what to do while we wait for answers.
Although effective treatment of antiretroviral-associated metabolic abnormalities ultimately depends on understanding the mechanisms involved, clinicians facing these problems are beginning to feel compelled to do something now to manage treatment-related metabolic complications. Diet and exercise should not be overlooked, because both can be effective in managing these complications without causing further side effects. Fibric acid derivatives such as gemfibrozil and statins can lower HIV-associated cholesterol and triglyceride levels, although further data are needed on problematic interactions between statins and protease inhibitors (PIs). Hypoglycemic agents may have some role in managing glucose abnormalities, although troglitazone cannot be recommended for fat abnormalities alone and metformin may cause lactic acidosis. Growth hormone and anabolic steroids may have some role in treating lipodystrophy, but the cost of growth hormone is prohibitive for many patients and definitive data on efficacy are lacking. Replacing a PI with a reverse transcriptase inhibitor has improved lipid and glucose levels in some studies. However, that strategy begs the question of how the nucleosides might contribute to lipodystrophy.
Currier
J S
JS
Department of Medicine, University of California, Los Angeles, USA.
D045930:Anabolic Agents / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000009:adverse effects*; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000069059:Atorvastatin; D005081:Exercise Therapy; D015248:Gemfibrozil / Q000627:therapeutic use; D013006:Growth Hormone / Q000627:therapeutic use; D017408:Guidelines as Topic; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008060:Lipodystrophy / Q000139:chemically induced; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000178:diet therapy; D008687:Metformin / Q000627:therapeutic use; D009705:Nucleosides / Q000009:adverse effects; D011480:Protease Inhibitors / Q000009:adverse effects; D011758:Pyrroles / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects; D012307:Risk Factors; D013844:Thiazoles / Q000627:therapeutic use; D045162:Thiazolidinediones
D045930:Anabolic Agents; D019380:Anti-HIV Agents; D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D009705:Nucleosides; D011480:Protease Inhibitors; D011758:Pyrroles; D018894:Reverse Transcriptase Inhibitors; D013844:Thiazoles; D045162:Thiazolidinediones; D013006:Growth Hormone; D008687:Metformin; D000069059:Atorvastatin; C089946:2,4-thiazolidinedione; D015248:Gemfibrozil