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Therapy Insight: body-shape changes and metabolic complications associated with HIV and highly active antiretroviral therapy

Nature Clinical Practice Endocrinology & Metabolism volume 3, pages 651–661 (2007)Cite this article

Abstract

Increasingly effective therapies for HIV infection are now available. These treatments, referred to collectively as highly active antiretroviral therapy, comprise various combinations of anti-HIV drugs from different drug classes. Recently, a range of metabolic complications have emerged as important toxicities in treated patients. Complications present as abnormalities of body-fat mass distribution in association with an often significant dyslipidemia and glucose homeostasis dysregulation. The body-shape changes, manifesting as peripheral lipoatrophy or central lipohypertrophy, can have a negative impact on quality of life and consequently on adherence to treatment. The combination of central lipohypertrophy, dyslipidemia and insulin resistance is associated with accelerated rates of atherosclerosis and other potentially significant long-term effects. The pathogenesis of these effects is complex and is still being actively investigated. Possible contributing factors relate to host characteristics, HIV viral parameters and specific effects of anti-HIV drugs on adipose-tissue biology and on intermediary metabolism. Management of these complications involves manipulation of the anti-HIV drugs using an understanding of their particular effects on lipid and glucose metabolism, in association with standard therapeutic interventions. Individualized approaches, taking into consideration quality-of-life issues, and assessment of potential cardiovascular risks, are now an important component of effective care of HIV-infected patients.

Key Points

  • Newly identified body-shape changes and associated metabolic abnormalities exert a significant impact on the clinical management of treated HIV-infected patients

  • The risk factors for the metabolic abnormalities are varied and include factors unrelated to HIV, factors related to HIV, and factors related to specific anti-HIV drugs

  • The body-shape changes can have significant impact on patients' quality of life, with potentially profound effects on adherence to effective therapies

  • Long-term consequences of the resulting dyslipidemia and glucose homeostasis abnormalities, acting in concert with general cardiovascular disease factors, contribute to an increase in cardiovascular disease

  • Specific HIV-positive populations, including persons co-infected with hepatitis C virus, children and persons from nonindustrialized countries, might have additional features putting them at special risk for these metabolic complications

  • The availability of new treatment choices, in addition to proper treatment of general cardiovascular disease risk factors, and use of an individualized approach to effective anti-HIV therapy, will assist in the careful long-term management of these individuals

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Acknowledgements

Désirée Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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  1. HIV Metabolic Clinic, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, Room A5.140, Montreal, QC H3G 1A4, Canada julian.falutz@muhc.mcgill.ca

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  1. J Falutz is Assistant Professor of Medicine at McGill University, and Associate Physician at the Montreal General Hospital site of the McGill University Health Center, Montreal, Quebec, Canada.,

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The author has declared associations with the following companies: he is on the Advisory Boards of Abbott Laboratories Canada and Boehringer Ingelheim Canada; he is on the Speaker Bureaus of Abbott Laboratories Canada, Bristol-Myers Squibb Canada, Boehringer Ingelheim Canada and GlaxoSmithKline Canada; and he is a consultant for Theratechnologies Canada.

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Falutz, J. Therapy Insight: body-shape changes and metabolic complications associated with HIV and highly active antiretroviral therapy. Nat Rev Endocrinol 3, 651–661 (2007). https://doi.org/10.1038/ncpendmet0587

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