Metabolic complications and antiretroviral therapy
Authors:
S. Snopková; K. Povolná; P. Husa
Authors‘ workplace:
Přednosta: prof. MUDr. Petr Husa, CSc.
; Klinika infekčních chorob Lékařské fakulty MU a FN Brno-Bohunice
Published in:
Prakt. Lék. 2008; 88(11): 630-634
Category:
Reviews
Overview
The clinical course of HIV/AIDS has been substantially modified by improved therapy in recent years. The progress of the disorder has changed – today it is a chronic disease with a long course. Long-term cART (combination antiretroviral therapy) significantly affects the subsequent progress of the disease but produces adverse metabolic changes – dyslipidaemia, insulin resistance, coagulation changes, antropometric changes – lipodystrophy, lipoatrophy and so on. The most prominent clinical signs have been defined as a new syndrome – “HIV-associated lipodystrophy syndrome”. HIV-associated lipodystrophy syndrome includes metabolic alterations (dyslipidaemia, insulin resistance) and abnormal fat redistribution. The paper discusses the possible pathogenesis and potential mechanisms of the metabolic complications related to cART – defective activation and nuclear translocation SREBP-1, inhibition of GLUT 4, proteasomal inhibition and mitochondrial toxicity. But current data indicate a rather multifactorial pathogenesis where HIV infection, its therapy, and patient-related factors are major contributors. The paper discusses the possible impact of cART on cardiovascular risk and the possibilities of hypolipidaemic therapy in HIV-positive patients.
Key words:
HIV, cART, dyslipidaemia, insulin resistance, fat redistribution, lipodystrophy syndrome, cardiovascular risk.
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