Approach to the human immunodeficiency virus-infected patient with lipodystrophy.
Subcutaneous atrophy and central fat accumulation are common among HIV-infected patients receiving highly active antiretroviral therapy, and may be accompanied by dyslipidemia and insulin resistance. These fat changes, although commonly referred to together as lipodystrophy, are best considered as separate disorders, with distinct pathogeneses and treatment approaches. These morphological and metabolic abnormalities first appeared after introduction of protease inhibitors more than 10 yr ago, but research has demonstrated that their pathogenesis is multifactorial, with contributions from other antiretroviral medications, patient-related factors, and HIV itself. Switching to a less toxic highly active antiretroviral therapy regimen has shown partial effectiveness for the management of fat atrophy and lipid abnormalities. Lifestyle modification or surgical approaches are the treatment of choice for lipohypertrophy, although novel therapies targeting the GH axis show promise. HIV-related dyslipidemia may be difficult to treat, and can be complicated by drug-drug interactions between some lipid-lowering medications and antiretroviral medications. Treatment of diabetes in HIV-infected patients should generally follow established guidelines, but thiazolidinediones, rather than metformin, may be considered first-line treatment in a patient with lipoatrophy, given their potential to increase sc fat. The contribution of body fat changes and metabolic abnormalities to cardiovascular risk and the changing risk profiles of newer antiretroviral regimens are under intense investigation.
Brown
Todd T
TT
Division of Endocrinology and Metabolism, Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, Maryland 21287, USA. tbrown27@jhmi.edu.
D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology; D003920:Diabetes Mellitus / Q000209:etiology; D050171:Dyslipidemias / Q000209:etiology; D013007:Growth Hormone-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007333:Insulin Resistance; D008060:Lipodystrophy / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D013007:Growth Hormone-Releasing Hormone; C479538:tesamorelin