[Effect of anti-retroviral therapy on body composition changes: a literature review].
Protein-energetic malnutrition, characterized by both lean mass and fat depletion, was common in the pre-HAART era, and was associated with shortened survival and diminished quality of life. The pathogenesis of protein-energy malnutrition was multifactorial, and nutritional treatments were largely ineffective in the absence of disease stabilization. The introduction of HAART brought markedly improved outcomes, including a decrease in the incidence of malnutrition. However, other nutritional and metabolic alterations were noticed, and included changes in body shape, both lipoatrophy and lipohypertrophy, as well as changes in metabolism, notably hyperlipidemia and insulin resistance. These conditions, though sometimes occurring together, may occur independently, suggesting a complex, multifactorial cause. Several mechanisms have been hypothesized, including impairment to adipocyte differentiation and adipokine regulation, production of proinflammatory cytokines and mitochondrial toxicity. The role of the single drug class is still unclear, because both PI and NRTI have been associated with the syndrome, and the therapeutic protocols include both groups. Most of the medical therapies proposed for lipodystrophy are ineffective, and even if surgery remains an alternative, it is not associated with long lasting outcomes.
Dell'Isola
C
C
VIII Divisione Dipartimento Urgenze Infettivologiche ad Alta Complessita, A.O. D. Cotugno, Napoli, Italy.
Aprea
L
L
Pizzella
T
T
Izzo
C
C
D000273:Adipose Tissue / Q000187:drug effects / Q000473:pathology; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001284:Atrophy; D001823:Body Composition / Q000187:drug effects*; D003131:Combined Modality Therapy; D016207:Cytokines / Q000502:physiology; D050171:Dyslipidemias / Q000139:chemically induced / Q000188:drug therapy; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D006801:Humans; D006984:Hypertrophy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008928:Mitochondria / Q000378:metabolism
D019380:Anti-HIV Agents; D016207:Cytokines; D000960:Hypolipidemic Agents