Hepatitis C, human immunodeficiency virus and metabolic syndrome: interactions.
Significant concerns have been raised about the metabolic effects of antiretroviral medication, including the classic triad of dyslipidaemia, insulin resistance (IR) and characteristic alterations in fat distribution (lipoatrophy and lipohypertrophy). Co-infection with hepatitis C appears to exacerbate IR, reduce serum lipids and induce prothrombotic changes in the treated human immunodeficiency virus patient. The effects of co-infection are complex. While combination antiretroviral therapy has been shown to be associated with an increased risk of cardiovascular events through promotion of dyslipidaemia, IR and fat redistribution, co-infection exacerbates IR while reducing serum lipids. Co-infection also promotes a prothrombotic state characterized by endothelial dysfunction and platelet activation, which may enhance risk for cardiovascular disease. Consideration must be given to selection of appropriate treatment regimens and timing of therapy in co-infected patients to minimize metabolic derangements and, ultimately, reduce cardiovascular risk.
Kotler
Donald P
DP
Division of Gastroenterology and Liver Disease, St Lukes-Roosevelt Hospital Center, New York, NY 10025, USA. dkotler@chpnet.org
D000273:Adipose Tissue / Q000187:drug effects*; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D024821:Metabolic Syndrome / Q000209:etiology* / Q000378:metabolism
D044966:Anti-Retroviral Agents