[Changes in carbohydrate metabolism in the HIV/AIDS patient].
Over the last few years, there has been a considerable reduction in the mortality and morbidity associated with HIV patients, due to the use of protease inhibitors which have led to a true revolution in the treatment of this infection. A new problem has arisen with the increased life expectancy: the onset of a plurimetabolic syndrome characterized by hypertriglyceridaemia, hypercholesterolaemia and hyperglycaemia; in addition to anomalies in composition and distribution of body fat (central obesity and loss of peripheral fat) due to the associated lipodystrophy. As a result of the metabolic alterations, there is an increase in the risk of cardiovascular disease. Hyperglycaemia is the result of insulin resistance and is detected in between 13.6% and 46% of patients, possibly leading to type 2 diabetes (diagnosed in between 2.4% and 7% of the patients). These alterations have been documented as potentially related with the use of protease inhibitors and other drugs used in the handling of HIV patients. The appropriate treatment of altered metabolism of carbohydrate requires: 1) a customized dietary approach depending on individual BMI and lipid alterations; 2) a physical exercise programme; 3) the use of insulin sensitization drugs: metformin and thiazolidinediones and, where the therapeutic goals are not achieved or there is a contraindication for oral hypoglycaemic drugs; 4) insulin therapy with regimens similar to other diabetic patients.
Gómez Candela
C
C
Unidad de Nutrición Clínica y Dietética, Hospital Universitario La Paz, Paseo de la Castellana, 261, 28046 Madrid. nutricion@hulp.insalud.es
de Cos Blanco
A I
AI
Mateo
R
R
Castro
E
E
Lorenzo
A
A
Polo
R
R
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000378:metabolism; D019380:Anti-HIV Agents / Q000009:adverse effects*; D050260:Carbohydrate Metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced / Q000178:diet therapy / Q000188:drug therapy; D005081:Exercise Therapy; D015658:HIV Infections / Q000188:drug therapy / Q000378:metabolism*; D017320:HIV Protease Inhibitors / Q000009:adverse effects; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced; D015228:Hypertriglyceridemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance; D008060:Lipodystrophy / Q000139:chemically induced; D008687:Metformin / Q000627:therapeutic use; D015995:Prevalence; D012307:Risk Factors; D013844:Thiazoles / Q000627:therapeutic use; D045162:Thiazolidinediones
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin; D013844:Thiazoles; D045162:Thiazolidinediones; D008687:Metformin; C089946:2,4-thiazolidinedione