Treatment options for HIV-associated central fat accumulation.
Central fat accumulation is increasingly recognized as a problem for patients with HIV infection. The term "lipodystrophy" has been used to describe collectively a constellation of body habitus changes and metabolic abnormalities commonly observed in HIV-infected patients, particularly since the advent of highly active antiretroviral therapy. Visceral fat accumulation can place patients at increased risk of coronary artery disease.Furthermore, body shape changes are a source of distress to patients that may compromise treatment adherence.Reduction of abdominal obesity can therefore be considered part of therapy in HIV-positive patients with visceral adipose tissue (VAT) accumulation. Currently, there are no drugs approved by the Food and Drug Administration for the treatment of HIV-associated central fat accumulation. Lifestyle modifications such as diet and exercise and switching antiretroviral therapies appear to be of limited value in reducing VAT. Metformin has shown some benefit in reducing VAT but at the expense of accelerating peripheral fat loss, and the thiazolidinediones have no effect on VAT. Similarly, testosterone does not appear to reduce VAT in these patients,and there are no data on anabolic steroids. Two large, randomized controlled trials have demonstrated the efficacy of recombinant human growth hormone (rhGH) in reducing visceral adipose tissue. There are also promising data regarding treatment with growth hormone releasing hormone (GHRH).
Cofrancesco
Joseph
J
Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Freedland
Eric
E
McComsey
Grace
G
D000728:Androgens / Q000627:therapeutic use; D000886:Anthropometry; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects / Q000379:methods; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D013006:Growth Hormone / Q000627:therapeutic use; D013007:Growth Hormone-Releasing Hormone / Q000627:therapeutic use; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D055118:Medication Adherence; D008687:Metformin / Q000627:therapeutic use; D015995:Prevalence; D011788:Quality of Life; D012107:Research Design; D012307:Risk Factors; D013739:Testosterone / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D000728:Androgens; D019380:Anti-HIV Agents; D006728:Hormones; D007004:Hypoglycemic Agents; D013739:Testosterone; D013006:Growth Hormone; D013007:Growth Hormone-Releasing Hormone; D008687:Metformin