Metabolic syndrome associated with HIV and highly active antiretroviral therapy.
The introduction of highly active antiretroviral therapy (HAART) has significantly improved the clinical outcome of HIV disease with increased survival rates. However, some HAART regimens, especially those including protease inhibitors, have been shown to cause in a high proportion of HIV-infected patients metabolic (dyslipidemia, insulin resistance) and somatic (lipodystrophy/lipoatrophy) changes that are associated with an increased risk of cardiovascular disease (coronary artery disease and stroke). The pathogenesis of HAART-associated metabolic syndrome and of its atherogenic profile is complex, and several factors are involved, including direct effects of HAART on lipid metabolism, endothelial and adipocyte cell function, activation of proinflammatory cytokines, and mitochondrial dysfunction. A better understanding of the molecular mechanisms responsible for this syndrome will lead to the discovery of new drugs that will reduce the incidence of lipodystrophy and related metabolic complications in HIV-infected patients facing long-term HAART.
Barbaro
Giuseppe
G
Cardiology Unit, Department of Medical Pathophysiology, University La Sapienza, Viale Anicio Gallo 63, 00174 Rome, Italy. g.barbaro@tin.it
Iacobellis
Gialuca
G
D054392:Adipokines / Q000502:physiology; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D008060:Lipodystrophy / Q000209:etiology / Q000378:metabolism; D024821:Metabolic Syndrome / Q000139:chemically induced* / Q000503:physiopathology; D008928:Mitochondria / Q000502:physiology; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D013577:Syndrome; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology
D054392:Adipokines; D011480:Protease Inhibitors; D014409:Tumor Necrosis Factor-alpha