title: HIV infection, body composition changes and related metabolic complications: contributing factors and evolving management strategies.
abstract: OBJECTIVE
  Metabolic toxicities in HIV patients are common and contribute to clinical status and long-term sequelae. Body fat mass alterations, of multifactorial causes, continue to occur, despite use of antiretroviral drugs associated with fewer metabolic side-effects. The role of HIV itself in the development of these changes is being better defined and a deeper understanding of perturbations in intermediary metabolic processes is emerging. Treatment options are also being identified.
  
  
  RESULTS
  HIV itself may be a direct causal factor in the accelerated atherosclerosis and decreased levels of high-density lipoprotein that occur and contribute to increased cardiovascular complications. Antiretroviral drug-related and inflammation-related effects can cause mitochondrial toxicity and are an emerging area of research. The association of increased visceral adipose tissue with both drug-related and chronic inflammation-related factors is now better understood. The role of accelerated aging as a paradigm is useful to understand long-term outcome risks for patients. The use of growth hormone-releasing factor as a viable treatment option for increased visceral abdominal tissue has recently been confirmed for selected patients.
  
  
  CONCLUSIONS
  Metabolic issues persist in HIV patients who are otherwise stable. Understanding the various inter-related contributing factors has allowed for rapid improvement in patients' clinical status, but long-term consequences are of concern and require ongoing investigation in order to prevent limiting the otherwise important clinical achievements that have recently occurred.
authors: McGill University Health Center, Immunodeficiency Treatment Center, Montreal, Quebec, Canada.
authors: Julian
authors: J
authors: Falutz
mesh_terms: D050153:Abdominal Fat / Q000378:metabolism*; D000375:Aging / Q000502:physiology; D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active; D001823:Body Composition; D002318:Cardiovascular Diseases / Q000209:etiology*; D013007:Growth Hormone-Releasing Hormone / Q000627:therapeutic use; D006678:HIV; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008928:Mitochondria; D056128:Obesity, Abdominal / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents; D013007:Growth Hormone-Releasing Hormone