Skip to main content

Lessons from HIV Lipodystrophy and Drug-Induced Metabolic Dysfunction

  • Chapter
  • First Online:
Metabolic Basis of Obesity
  • 1838 Accesses

Abstract

With the introduction of highly active antiretroviral therapy (HAART), metabolic and body composition changes are increasingly observed among HIV-infected patients. These changes are characterized by lipoatrophy of subcutaneous abdominal, extremity and facial fat, increased visceral fat, as well as dyslipidemia and insulin resistance, and have been viewed by many to constitute an acquired lipodystrophy syndrome. The etiology of this syndrome is clearly multifactorial and it is not a homogenous syndrome, but rather exhibits significant heterogeneity depending on environmental, genetic, and treatment factors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hellerstein, M. K., Grunfeld, C., Wu, K., Christiansen, M., Kaempfer, S., Kletke, C., et al. (1993). Increased de novo hepatic lipogenesis in human immunodeficiency virus infection. J Clin Endocrinol Metab, 76(3), 559–565.

    Article  CAS  PubMed  Google Scholar 

  2. Grunfeld, C., Pang, M., Doerrler, W., Shigenaga, J. K., Jensen, P., Feingold, K. R., (1992). Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocrinol Metab, 74(5), 1045–1052.

    Article  CAS  PubMed  Google Scholar 

  3. Dube, M.P., Parker, R.A., Tebas, P., Grinspoon, S.K., Zackin, R.A., Robbins, G.K., et al. (2005). Glucose metabolism, lipid, and body fat changes in antiretroviral-naive subjects randomized to nelfinavir or efavirenz plus dual nucleosides. Aids, 19(16), 1807-1818.

    CAS  Google Scholar 

  4. Mallon, P.W., Miller, J., Cooper, D.A., Carr, A. (2003). Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1-infected men starting therapy. AIDS, 17(7), 971–979.

    CAS  Google Scholar 

  5. Dolan, S.E., Hadigan, C., Killilea, K.M., Sullivan, M.P., Hemphill, L., Lees, R.S., et al. (2005). Increased cardiovascular disease risk indices in HIV-infected women. J Acquir Immune Defic Syndr, 39(1), 44–54.

    Article  PubMed  Google Scholar 

  6. Tong, Q., Sankale, J.L., Hadigan, C.M., Tan, G., Rosenberg, E.S., Kanki, P.J., et al. (2003). Regulation of adiponectin in human immunodeficiency virus-infected patients: relationship to body composition and metabolic indices. J Clin Endocrinol Metab, 88(4), 1559–1564.

    Article  CAS  PubMed  Google Scholar 

  7. Hadigan, C., Meigs, J. B., Rabe, J., D’Agostino, R. B., Wilson, P. W., Lipinska, I., et al. (2001). Increased PAI-1 and tPA antigen levels are reduced with metformin therapy in HIV-infected patients with fat redistribution and insulin resistance. J Clin Endocrinol Metab, 86(2), 939–943.

    Article  CAS  PubMed  Google Scholar 

  8. Riddler, S. A., Smit, E., Cole, S. R., Li, R., Chmiel, J. S., Dobs, A., et al. (2003). Impact of HIV Infection and HAART on Serum Lipids in Men, JAMA 289(22), 2978–2982.

    Article  CAS  PubMed  Google Scholar 

  9. Brown, T. T., Cole, S. R., Li, X., Kingsley, L. A., Palella, F. J., Riddler, S. A., et al. (2005). Antiretroviral therapy and the prevalence and incidence of diabetes mellitus in the multicenter AIDS cohort study. Arch Intern Med 165(10), 1179–1184.

    Article  PubMed  Google Scholar 

  10. Gan, S. K., Samaras, K., Thompson, C. H., Kraegen, E. W., Carr, A., Cooper, D. A., et al. (2002). Altered myocellular and abdominal fat partitioning predict disturbance in insulin action in HIV protease inhibitor-related lipodystrophy. Diabetes 51(11), 3163–3169.

    Article  CAS  PubMed  Google Scholar 

  11. He, Q., Engelson, E. S., Ionescu, G., Glesby, M. J., Albu, J. B., Kotler, D. P. (2008). Insulin resistance, hepatic lipid and adipose tissue distribution in HIV-infected men, Antivir Ther. 13(3), 423–428.

    PubMed  Google Scholar 

  12. Hadigan, C., Kamin, D., Liebau, J., Mazza, S., Barrow, S., Torriani, M., et al. (2006). Depot-specific regulation of glucose uptake and insulin sensitivity in HIV-lipodystrophy. Am J Physiol Endocrinol Metab, 290(2), E289–298.

    Article  CAS  PubMed  Google Scholar 

  13. Mynarcik, D.C., McNurlan, M.A., Steigbigel, R.T., Fuhrer, J., Gelato, M.C. (2000). Association of severe insulin resistance with both loss of limb fat and elevated serum tumor necrosis factor receptor levels in HIV lipodystrophy. J Acquir Immune Defic Syndr, 25(4), 312–321.

    Article  CAS  PubMed  Google Scholar 

  14. Hadigan, C., Borgonha, S., Rabe, J., Young, V., Grinspoon, S. (2002). Increased rates of lipolysis among human immunodeficiency virus-infected men receiving highly active antiretroviral therapy. Metabolism, 51(9), 1143–1147.

    Article  CAS  PubMed  Google Scholar 

  15. Behrens, G. M., Boerner, A. R., Weber, K., van den Hoff, J., Ockenga, J., Brabant, G., et al. (2002). Impaired glucose phosphorylation and transport in skeletal muscle cause insulin resistance in HIV-1-infected patients with lipodystrophy. Journal of Clinical Investigation, 110(9), 1319–1327.

    CAS  PubMed  Google Scholar 

  16. Murata, H., Hruz, P. W., Mueckler, M. (2000). The mechanism of insulin resistance caused by HIV protease inhibitor therapy. J Biol Chem, 275(27), 20251–20254.

    Article  CAS  PubMed  Google Scholar 

  17. Noor, M. A., Seneviratne, T., Aweeka, F. T., Lo, J. C., Schwarz, J. M., Mulligan, K., et al. (2002). Indinavir acutely inhibits insulin-stimulated glucose disposal in humans: a randomized, placebo-controlled study. AIDS, 16(5), F1–8

    Google Scholar 

  18. Carper, M. J., Cade, W. T., Cam, M., Zhang, S., Shalev, A., Yarasheski, K. E., et al. (2008). HIV-protease inhibitors induce expression of suppressor of cytokine signaling-1 in insulin-sensitive tissues and promote insulin resistance and type 2 diabetes mellitus. Am J Physiol Endocrinol Metab, 294(3), E558–567.

    Article  CAS  PubMed  Google Scholar 

  19. Purnell, J. Q., Zambon, A., Knopp, R. H., Pizzuti, D. J., Achari, R., Leonard J. M., et al. (2000). Effect of ritonavir on lipids and post-heparin lipase activities in normal subjects. AIDS, 14(1), 51–57.

    CAS  Google Scholar 

  20. Bastard, J. P., Caron, M., Vidal, H., Auclair, M., Vigouroux, C., Luboinski, J., et al. (2002). Association between altered expression of adipogenic factor SREBP1 in lipoatrophic adipose tissue from HIV-1-infected patients and abnormal adipocyte differentiation and insulin resistance. Lancet, 359(9311), 1026–1031.

    Article  CAS  PubMed  Google Scholar 

  21. Caron, M., Vigouroux, C., Bastard, J. P., Capeau, J., (2009). Antiretroviral-Related Adipocyte Dysfunction and Lipodystrophy in HIV-Infected Patients: Alteration of the PPARgamma-Dependent Pathways. PPAR Res, 2009:507141. Epub 2008 Dec 30. PMID: 19125203 [PubMed - in process].

    Article  PubMed  Google Scholar 

  22. Adler-Wailes, D. C., Guiney, E. L., Koo, J., Yanovski, J. A. (2008). Effects of ritonavir on adipocyte gene expression: evidence for a stress-related response. Obesity (Silver Spring). 16 (10), 2379–2387.

    Article  CAS  Google Scholar 

  23. Fleischman, A., Johnsen, S,, Systrom, D. M., Hrovat. M., Farrar, C. T., Frontera W., et al. (2007). Effects of a nucleoside reverse transcriptase inhibitor, stavudine, on glucose disposal and mitochondrial function in muscle of healthy adults. Am J Physiol Endocrinol Metab. 292(6), E1666–1673.

    Article  CAS  PubMed  Google Scholar 

  24. Ranade, K., Geese, W. J., Noor, M., Flint, O., Tebas, P., Mulligan, K., et al. (2008). Genetic analysis implicates resistin in HIV lipodystrophy. Aids. 22(13), 1561–1568.

    CAS  Google Scholar 

  25. Hulgan, T., Tebas, P., Canter, J. A., Mulligan, K., Haas, D. W., Dubé, M., et al. (2008). Hemochromatosis gene polymorphisms, mitochondrial haplogroups, and peripheral lipoatrophy during antiretroviral therapy. J Infect Dis. 197(6), 858–866.

    Article  CAS  PubMed  Google Scholar 

  26. Zanone Poma, B., Riva, A., Nasi, M., Zanone Poma, B., Riva, A., Nasi, M., et al. (2008). Genetic polymorphisms differently influencing the emergence of atrophy and fat accumulation in HIV-related lipodystrophy. Aids. 22(14), 1769–1778.

    Google Scholar 

  27. Bonnet, E., Bernard, J., Fauvel, J., Massip, P., Ruidavets, J. B., Perret, B. (2008). Association of APOC3 polymorphisms with both dyslipidemia and lipoatrophy in HAART-receiving patients. AIDS Res Hum Retroviruses. 24(2), 169–171.

    Article  CAS  PubMed  Google Scholar 

  28. Nasi, M., Guaraldi, G., Orlando, G., Nasi, M., Guaraldi, G., Orlando, G., et al. (2008). Mitochondrial DNA haplogroups and highly active antiretroviral therapy-related lipodystrophy. Clin Infect Dis. 47(7), 962–968.

    Article  PubMed  Google Scholar 

  29. Maher, B., Alfirevic, A., Vilar, F. J., Wilkins, E. G., Park, B. K., Pirmohamed, M. (2002). TNF-alpha promoter region gene polymorphisms in HIV-positive patients with lipodystrophy. Aids. 16(15), 2013–2018.

    CAS  Google Scholar 

  30. Asensi, V., Rego, C., Montes, A. H., Asensi, V., Rego, C., Montes, A. H., et al. (2008). IL-1beta (+3954C/T) polymorphism could protect human immunodeficiency virus (HIV)-infected patients on highly active antiretroviral treatment (HAART) against lipodystrophic syndrome. Genet Med. 10(3), 215–223.

    Article  CAS  PubMed  Google Scholar 

  31. Wilson, P. W., D’Agostino, R, B., Levy, D., Belanger, A. M., Silbershatz, H., Kannel, W. B. (1998). Prediction of coronary heart disease using risk factor categories. Circulation. 97(18), 1837–1847.

    CAS  PubMed  Google Scholar 

  32. Hadigan, C., Meigs, J. B., Wilson, P. W., Hadigan, C., Meigs, J. B., Wilson, P. W., et al. (2003). Prediction of coronary heart disease risk in HIV-infected patients with fat redistribution. Clin Infect Dis. 36(7), 909–916.

    Article  PubMed  Google Scholar 

  33. Law, M. G., Friis-Moller, N., El-Sadr, W. M., Weber, R., Reiss, P., D’Arminio Monforte, A., et al. (2006). The use of the Framingham equation to predict myocardial infarctions in HIV-infected patients: comparison with observed events in the D:A:D Study. HIV Medicine. 7(4), 218–230.

    Article  CAS  PubMed  Google Scholar 

  34. Schambelan, M., Wilson, P. W., Yarasheski, K. E., Cade, W. T., Dávila-Román, V. G., D’Agostino, R. B., Sr., et al. (2008). Development of appropriate coronary heart disease risk prediction models in HIV-infected patients. Circulation. 118(2), e48–53.

    Article  PubMed  Google Scholar 

  35. Friis-Moller, N., Sabin, C. A., Weber, R., d’Arminio Monforte, A., El-Sadr, W. M., Reiss, P., et al. (2003). Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 349(21), 1993–2003.

    Article  PubMed  Google Scholar 

  36. Triant, V. A., Lee, H., Hadigan, C., Grinspoon, S. K. (2007). Increased Acute Myocardial Infarction Rates and Cardiovascular Risk Factors Among Patients with HIV Disease. J Clin Endocrinol Metab. 92, 2506–2512.

    Article  CAS  PubMed  Google Scholar 

  37. Triant, V. A., Meigs, J. B., Grinspoon, S. (2008). Association of C-Reactive Protein and HIV Infection with Acute Myocardial Infarction. Paper presented at: 10th International Workshop on Adverse Drug Reactions and Lipodystrophy; November 6–8, London, UK.

    Google Scholar 

  38. El-Sadr, W. M., Lundgren, J. D., Neaton, J. D., Gordin, F., Abrams, D., Arduino, R. C., et al. (2006). CD4+ count-guided interruption of antiretroviral treatment. N Engl J Med. 355(22), 2283–2296.

    Article  CAS  PubMed  Google Scholar 

  39. Hsue, P. Y., Lo, J. C., Franklin, A., Bolger, A. F., Martin, J. N., Deeks, S. G., et al. (2004). Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation. 109, 1603–1608.

    Article  PubMed  Google Scholar 

  40. Currier, J. S., Kendall, M. A., Zackin, R., Henry, W. K., Alston-Smith, B., Torriani, F. J., et al. (2005). Carotid artery intima-media thickness and HIV infection: traditional risk factors overshadow impact of protease inhibitor exposure. Aids. 19(9), 927–933.

    CAS  Google Scholar 

  41. Mondy, K. E., de las Fuentes, L., Waggoner, A., Onen, N. F., Bopp, C. S., Lassa-Claxton, S., et al. (2008). Insulin resistance predicts endothelial dysfunction and cardiovascular risk in HIV-infected persons on long-term highly active antiretroviral therapy. Aids. 22(7), 849–856.

    CAS  Google Scholar 

  42. Gerber, J. G., Kitch, D. W., Fichtenbaum, C. J., Zackin, R. A., Charles, S., Hogg, E., et al. (2008). Fish oil and fenofibrate for the treatment of hypertriglyceridemia in HIV-infected subjects on antiretroviral therapy: results of ACTG A5186. J Acquir Immune Defic Syndr. 47(4), 459–466.

    Article  CAS  PubMed  Google Scholar 

  43. Dube, M. P., Wu, J. W., Aberg, J. A., Deeg, M. A., Alston-Smith, B. L., McGovern, M. E., et al. (2006). Safety and efficacy of extended-release niacin for the treatment of dyslipidaemia in patients with HIV infection: AIDS Clinical Trials Group Study A5148. Antivir Ther. 11(8), 1081–1089.

    CAS  PubMed  Google Scholar 

  44. De Truchis, P., Kirstetter, M., Perier, A., Meunier, C., Zucman, D., Force, G., et al. (2007). Reduction in triglyceride level with N-3 polyunsaturated fatty acids in HIV-infected patients taking potent antiretroviral therapy: a randomized prospective study. J Acquir Immune Defic Syndr. 44(3), 278–285.

    Article  CAS  PubMed  Google Scholar 

  45. Fichtenbaum., C. J., Gerber, J. G., Rosenkranz, S. L., Segal, Y., Aberg, J. A., Blaschke, T., et al. (2002). Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG Study A5047. AIDS. 16(4), 569–577.

    CAS  Google Scholar 

  46. Gerber, J. G., Rosenkranz, S. L., Fichtenbaum, C. J., Vega, J. M., Yang, A., Alston, B. L., et al. (2005). Effect of efavirenz on the pharmacokinetics of simvastatin, atorvastatin, and pravastatin: results of AIDS Clinical Trials Group 5108 Study. J Acquir Immune Defic Syndr. 39(3), 307–312.

    Article  CAS  PubMed  Google Scholar 

  47. Meininger, G., Hadigan, C., Laposata, M., Brown, J., Rabe, J., Louca, J., et al. (2002). Elevated concentrations of free fatty acids are associated with increased insulin response to standard glucose challenge in human immunodeficiency virus-infected subjects with fat redistribution. Metabolism. 51(2), 260–266.

    Article  CAS  PubMed  Google Scholar 

  48. Hadigan, C., Liebau, J., Torriani, M., Andersen, R., Grinspoon, S. (2006). Improved tirglycerides and insulin sensitivitywith 3 months of acipimox in human immunodeficiency virus-infected patients with hypertriglyceridemia. J Clin Endocrinol Metab. 91, 4439–4444.

    Article  Google Scholar 

  49. Zhou, G., Myers, R., Li, Y., Chen, Y., Shen, X., Fenyk-Melody, J., et al. (2001). Role of AMP-activated protein kinase in mechanism of metformin action. J Clin Invest. 108(8):1167–1174.

    CAS  PubMed  Google Scholar 

  50. Hadigan, C., Corcoran, C., Basgoz, N., Davis, B., Sax, P., Grinspoon, S. (2000). Metformin in the treatment of HIV lipodystrophy syndrome: A randomized controlled trial. JAMA. 284(4), 472–477.

    Article  CAS  PubMed  Google Scholar 

  51. Arioglu, E., Duncan-Morin, J., Sebring, N., Rother, K. I., Gottlieb, N., Lieberman, J., et al. (2000). Efficacy and safety of troglitazone in the treatment of lipodystrophy syndromes. Ann Intern Med. 133(4), 263–274.

    CAS  PubMed  Google Scholar 

  52. Gavrilova, O., Marcus-Samuels, B., Graham, D., Kim, J. K., Shulman, G. I., Castle, A. L., et al. (2000). Surgical implantation of adipose tissue reverses diabetes in lipoatrophic mice. J Clin Invest. 105(3), 271–278.

    Article  CAS  PubMed  Google Scholar 

  53. Hadigan, C., Yawetz, S., Thomas, A., Havers, F., Sax, P E., Grinspoon S. (2004). Metabolic effects of rosiglitazone in HIV lipodystrophy: A randomized controlled trial. Ann Intern Med. 140, (10)786–794.

    CAS  PubMed  Google Scholar 

  54. Sutinen, J., Hakkinen, A. M., Westerbacka, J., Seppälä-Lindroos, A., Vehkavaara, S., Halavaara, J., et al. (2003). Rosiglitazone in the treatment of HAART-associated lipodystrophy--a randomized double-blind placebo-controlled study. Antivir Ther. 8(3), 199–207.

    CAS  PubMed  Google Scholar 

  55. Sutinen, J., Kannisto, K., Korsheninnikova, E., Fisher, R. M., Ehrenborg, E., Nyman. T., et al. (2004). Effects of rosiglitazone on gene expression in subcutaneous adipose tissue in highly active antiretroviral therapy-associated lipodystrophy. Am J Physiol Endocrinol Metab. 286(6), E941–949.

    Article  CAS  PubMed  Google Scholar 

  56. Carr, A., Workman, C., Carey, D., Rogers, G., Martin, A., Baker, D., et al. (2004). No effect of rosiglitazone for treatment of HIV-1 lipoatrophy: randomized, double-blind, placebo-controlled trial. Lancet. 363(9407), 429–438.

    Article  CAS  PubMed  Google Scholar 

  57. Mulligan, K., Yang, Y., Wininger, D. A., Koletar, S. L., Parker, R. A., Alston-Smith, B. L., et al. (2007). Effects of Metformin and Rosiglitazone in HIV-Infected Patients with Hyperinsulinemia and Elevated Waist to Hip Ratio. AIDS. 21, 47–57.

    CAS  Google Scholar 

  58. Hadigan, C., Mazza, S., Crum, D., Grinspoon, S. (2007). Rosiglitazone increases small dense low-density lipoprotein concentration and decreases high-density lipoprotein particle size in HIV-infected patients. AIDS. 21(18), 2543–2546.

    CAS  Google Scholar 

  59. Mallon, P. W., Sedwell, R., Rogers, G., Nolan, D., Unemori, P., Hoy, J., et al. (2008). Effect of rosiglitazone on peroxisome proliferator-activated receptor gamma gene expression in human adipose tissue is limited by antiretroviral drug-induced mitochondrial dysfunction. J Infect Dis. 198(12), 1794–1803.

    Article  CAS  PubMed  Google Scholar 

  60. Belfort, R., Harrison, S. A., Brown, K., Darland, C., Finch, J., Hardies, J., et al. (2006). A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med. 355(22), 2297–2307.

    Article  CAS  PubMed  Google Scholar 

  61. Slama, L., Lanoy, E., Valantin, M. A., Bastard, J. P., Chermak, A., Boutekatjirt, A., et al. (2008). Effect of pioglitazone on HIV-1-related lipodystrophy: a randomized double-blind placebo-controlled trial (ANRS 113). Antivir Ther. 13(1), 67–76.

    CAS  PubMed  Google Scholar 

  62. Oral, E. A., Simha, V., Ruiz, E., Andewelt, A., Premkumar, A., Snell, P., et al. (2002). Leptin-replacement therapy for lipodystrophy. N Engl J Med. 346(8), 570–578.

    Article  CAS  PubMed  Google Scholar 

  63. Lee, J. H., Chan, J. L., Sourlas, E., Raptopoulos, V., Mantzoros, C. S. (2006). Recombinant methionyl human leptin therapy in replacement doses improves insulin resistance and metabolic profile in patients with lipoatrophy and metabolic syndrome induced by the highly active antiretroviral therapy. J Clin Endocrinol Metab. 91(7), 2605–2611.

    Article  CAS  PubMed  Google Scholar 

  64. Rietschel, P., Hadigan, C., Corcoran, C., Stanley, T., Neubauer, G., Gertner, J., et al. (2001). Assessment of growth hormone dynamics in human immunodeficiency virus-related lipodystrophy. J Clin Endocrinol Metab. 86(2), 504–510.

    Article  CAS  PubMed  Google Scholar 

  65. Koutkia, P., Meininger, G., Canavan, B., Breu, J., Grinspoon, S. (2004). Metabolic regulation of growth hormone by free fatty acids, somatostatin, and ghrelin in HIV-lipodystrophy. Am J Physiol Endocrinol Metab. 286(2), E296–303.

    Article  CAS  PubMed  Google Scholar 

  66. Grunfeld, C., Thompson, M., Brown, S. J., Richmond, G., Lee, D., Muurahainen, N., et al. (2007). Recombinant human growth hormone to treat HIV-associated adipose redistribution syndrome: 12 week induction and 24-week maintenance therapy. J Acquir Immune Defic Syndr. 45(3), 286–297.

    CAS  PubMed  Google Scholar 

  67. Lo, J., You, S. M., Canavan, B., Liebau, J., Beltrani, G., Koutkia, P., et al. (2008). Low-dose physiological growth hormone in patients with HIV and abdominal fat accumulation: a randomized controlled trial. JAMA. 300(5), 509–519.

    Article  CAS  PubMed  Google Scholar 

  68. Koutkia, P., Canavan, B., Breu, J., Torriani, M., Kissko, J., Grinspoon, S. (2004). Growth Hormone-Releasing Hormone in HIV-Infected Men With Lipodystrophy: A Randomized Controlled Trial. JAMA. 292(2), 210–218.

    Article  CAS  PubMed  Google Scholar 

  69. Falutz, J., Allas, S., Blot, K., Potvin, D., Kotler, D., Somero, M., et al. (2007). Metabolic effects of a growth hormone-releasing factor in patients with HIV. N Engl J Med. 357(23), 2359–2370.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Steven Grinspoon .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Grinspoon, S. (2011). Lessons from HIV Lipodystrophy and Drug-Induced Metabolic Dysfunction. In: Ahima, R. (eds) Metabolic Basis of Obesity. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1607-5_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4419-1607-5_18

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4419-1606-8

  • Online ISBN: 978-1-4419-1607-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics