HIV protease inhibitors and obesity.
OBJECTIVE
To review the current scientific literature and recent clinical trials on HIV protease inhibitors and their potential role in the pathogenesis of lipodystrophy and metabolic disorders.


RESULTS
HIV protease inhibitor treatment may affect the normal stimulatory effect of insulin on glucose and fat storage. Further, chronic inflammation from HIV infection and protease inhibitor treatment 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. This process leads to a pathologic cycle of lipodystrophy and lipotoxicity, a proatherogenic lipid profile, and a clinical phenotype of increased central body fat distribution similar to the metabolic syndrome.


CONCLUSIONS
Protease inhibitors are a key component of antiretroviral therapy and have dramatically improved the life expectancy of HIV-infected individuals. However, they are also associated with abnormalities in glucose/lipid metabolism and body fat distribution. Further studies are needed to better define the pathogenesis of protease inhibitor-associated metabolic and body fat changes and their potential treatment.
Anuurad
Erdembileg
E
Department of Medicine, University of California, Davis, Sacramento, CA 95817, USA.
Bremer
Andrew
A
Berglund
Lars
L
D017667:Adipocytes / Q000187:drug effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D050197:Atherosclerosis / Q000139:chemically induced; D050218:Body Fat Distribution; D005260:Female; D005947:Glucose / Q000378:metabolism; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000378:metabolism; D006801:Humans; D015994:Incidence; D050356:Lipid Metabolism / Q000187:drug effects; D008060:Lipodystrophy / Q000139:chemically induced; D024821:Metabolic Syndrome / Q000139:chemically induced; D009765:Obesity / Q000139:chemically induced* / Q000378:metabolism
D017320:HIV Protease Inhibitors; D005947:Glucose