The metabolic toxicities of antiretroviral therapy.
Since the adoption of highly active antiretroviral therapy (HAART) in the mid-1990s, certain metabolic toxicities have been increasingly recognized. These include a fat redistribution syndrome (lipohypertrophy, lipoatrophy), hyperlipidaemia, altered glucose metabolism and insulin resistance, mitochondrial toxicity (presenting as anaemia, myopathy, pancreatitis, neuropathy, hepatic steatosis and lactic acidosis), and bone density abnormalities (osteoporosis and osteonecrosis). Metabolic complications are principally reported with protease inhibitors and nucleoside reverse transcriptase inhibitors, but may be seen with all classes of antiretroviral therapy. In this review, we summarize the epidemiology, pathogenesis and management of these various toxicities.
Herman
J S
JS
Department of HIV/GUM, The Guy's, King's and St Thomas' School of Medicine, King's College Hospital, Cutcombe Road, London SE5 9RS, UK.
Easterbrook
P J
PJ
D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D001851:Bone Diseases, Metabolic / Q000139:chemically induced / Q000209:etiology; D004272:DNA, Mitochondrial / Q000187:drug effects; D004359:Drug Therapy, Combination; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000209:etiology; D006949:Hyperlipidemias / Q000139:chemically induced / Q000209:etiology; D008060:Lipodystrophy / Q000139:chemically induced / Q000209:etiology; D008659:Metabolic Diseases / Q000139:chemically induced* / Q000209:etiology; D008928:Mitochondria / Q000187:drug effects / Q000378:metabolism; D010020:Osteonecrosis / Q000139:chemically induced / Q000209:etiology
D019380:Anti-HIV Agents; D004272:DNA, Mitochondrial