title: The role of protease inhibitors in the pathogenesis of HIV-associated lipodystrophy: cellular mechanisms and clinical implications.
abstract: Metabolic complications associated with HIV infection and treatment frequently present as a relative lack of peripheral adipose tissue associated with dyslipidemia and insulin resistance. In this review we explain the connection between abnormalities of intermediary metabolism, observed either in vitro or in vivo, and this group of metabolic effects. We review molecular mechanisms by which the HIV protease inhibitor (PI) class of drugs may affect the normal stimulatory effect of insulin on glucose and fat storage. We then propose that both chronic inflammation from HIV infection and treatment with some drugs in this class trigger cellular homeostatic stress responses with adverse effects on intermediary metabolism. The physiologic outcome is such that total adipocyte storage capacity is decreased, and the remaining adipocytes resist further fat storage. The excess circulating and dietary lipid metabolites, normally "absorbed" by adipose tissue, are deposited ectopically in lean (muscle and liver) tissue, where they impair insulin action. This process leads to a pathologic cycle of lipotoxicity and lipoatrophy and a clinical phenotype of body fat distribution with elevated waist-to-hip ratio similar to the metabolic syndrome.
authors.affiliation: Pharmaceutical Research and Development, Bristol-Myers Squibb Company, Princeton, New Jersey 08543, USA. oliver.flint@bms.com
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Flint
authors.forename: Mustafa A
authors.initials: MA
authors.lastname: Noor
authors.forename: Paul W
authors.initials: PW
authors.lastname: Hruz
authors.forename: Phil B
authors.initials: PB
authors.lastname: Hylemon
authors.forename: Kevin
authors.initials: K
authors.lastname: Yarasheski
authors.forename: Donald P
authors.initials: DP
authors.lastname: Kotler
authors.forename: Rex A
authors.initials: RA
authors.lastname: Parker
authors.forename: Aouatef
authors.initials: A
authors.lastname: Bellamine
mesh_terms: D017667:Adipocytes / Q000187:drug effects / Q000378:metabolism; D000273:Adipose Tissue / Q000187:drug effects* / Q000378:metabolism; D000818:Animals; D002478:Cells, Cultured; D050171:Dyslipidemias / Q000209:etiology / Q000378:metabolism; D005947:Glucose / Q000378:metabolism; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D017320:HIV Protease Inhibitors / Q000009:adverse effects*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000187:drug effects / Q000378:metabolism; D024821:Metabolic Syndrome / Q000209:etiology* / Q000378:metabolism
chemical_list: D017320:HIV Protease Inhibitors; D007328:Insulin; D005947:Glucose