title: HIV-associated lipodystrophy: impact of antiretroviral therapy.
abstract: In the late 1990s, reports of unusual changes in body fat distribution named 'lipodystrophy' (LD) began to appear in HIV patients mitigating the enormous enthusiasm about improvement of survival and quality of life provided by the combinations of antiretroviral (ARV) drug classes, the so-called highly active antiretroviral therapy (HAART), which had just become available at that time. The objective of this paper is to critically review the literature on LD and to discuss the impact of newer ARV agents, namely atazanavir, darunavir and raltegravir, as well as strategies of the late HAART era, including single-tablet regimens and nucleoside-sparing regimens. Studies in which LD was measured by dual-energy x-ray absorptiometry or by abdominal computed tomography or magnetic resonance imaging scan only, were included. We were unable to identify studies depicting a negative impact of drugs or ARV regimens on limb fat loss. On the contrary, a few studies identified a negative impact of atazanavir/ritonavir or darunavir/ritonavir on trunk fat increase. It should be noted that this anthropometric measure is a poor instrument since it cannot distinguish between subcutaneous and visceral fat. We conclude that presumably the body fat changes currently observed in HIV-infected patients is the net result of competing phenomena: on one side the natural history of lipohypertrophy as a result of HIV and HAART impact, and on the other side the physiological body fat changes observed in the aging population.
authors.affiliation: Department of Medical and Surgical Sciences for Children & Adults, Universisty of Modena and Reggio Emilia, Largo del Pozzo ,71, 41124, Modena, Italy, giovanni.guaraldi@unimore.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.forename: Chiara
authors.initials: C
authors.lastname: Stentarelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Zona
authors.forename: Antonella
authors.initials: A
authors.lastname: Santoro
mesh_terms: D050154:Adiposity / Q000187:drug effects; D000375:Aging; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D000069446:Atazanavir Sulfate; D000069454:Darunavir; D004338:Drug Combinations; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology; D019428:HIV Integrase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D039682:HIV-Associated Lipodystrophy Syndrome / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D009705:Nucleosides / Q000378:metabolism; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D011760:Pyrrolidinones / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000068898:Raltegravir Potassium; D016032:Randomized Controlled Trials as Topic; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D044966:Anti-Retroviral Agents; D004338:Drug Combinations; D019428:HIV Integrase Inhibitors; D017320:HIV Protease Inhibitors; D009705:Nucleosides; D009842:Oligopeptides; D011725:Pyridines; D011760:Pyrrolidinones; D018894:Reverse Transcriptase Inhibitors; D013449:Sulfonamides; D000068898:Raltegravir Potassium; D000069446:Atazanavir Sulfate; D000069454:Darunavir