Potential Therapies for the HIV-Associated Lipodystrophy Syndrome
The HIV associated liposdystrophy syndrome consists of four parts that are likely to be related, but that appear to be able to exist independently in an HIV-infected individual (1, 2, 3, 4, 5, 6). These four components include: fat deposition (buffalo hump, visceral fat, breast enlargement), subcutaneous fat atrophy, disorders of glucose and insulin metabolism, most commonly manifest as glucose intolerance, and disorders of lipid and cholesterol metabolism, with elevations in total cholesterol, fasting triglycerides, and low density lipoprotein cholesterol (non-HDL cholesterol). The epidemiology and potential mechanisms for these are discussed in detail in other chapters in this book. It is clear that both of the body shape abnormalities are distressing to patients, and have lead to refusal to initiate anti-retroviral therapy or termination of ART by patients. In non-HIV-infected patients, visceral fat has a strong association with glucose intolerance and adverse cardiovascular events (7). In population studies, elevations in cholesterol and triglycerides and glucose intolerance/insulin resistance are associated with adverse outcomes as well (8, 9, 10, 11, 12). No definitive studies exist yet for HIV to assure us that the same ourcomes will occur with these metabolic abnormalities in the HIV infected patient, but there is sufficient concern that these association will hold, that interventions to attempt to control these metebolic abnormalities are being investigated.
KeywordsCholesterol Obesity Lipase Statin Triglyceride
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