Toxic metabolic syndrome associated with HAART

Abstract

Acquired fat redistribution, that is, peripheral fat loss often accompanied by central fat accumulation in patients with HIV infection is the most common form of lipodystrophy in man. Approximately 30 50% of HIV-infected individuals after 12months on highly active antiretroviral therapy (HAART) may encounter the HIV-associated lipodystrophy syndrome (HALS), which attenuates patient compliance to this treatment. HALS is characterised by impaired glucose and lipid metabolism and other risk factors for cardiovascular disease. This review depicts the metabolic abnormalities associated with HAART by describing the key cell and organ systems that are involved, emphasising the role of insulin resistance. An opinion on the remedies available to treat the metabolic abnormalities and phenotype of HALS is provided.

Keywords::

• adipocytokines
• HIV
• insulin sensitivity
• lipidaemia
• lipodystrophy
• mitochondria
• nucleoside reverse transcriptase inhibitors
• protease inhibitors

Acknowledgement

The Danish Diabetes Association, The Novo Nordisk Foundation, The Copenhagen Hospital Cooperation Foundation, Hvidovre University Hospital Research Foundation, The Danish AIDS Foundation, The Danish Medical Research Council Foundation and The A.P. Mller Foundation for the Advancement of Medical Science have funded part of this research.