Journal Article

HIV-associated lipodystrophy: a review of underlying mechanisms and therapeutic options

Jane E. Mallewa, Edmund Wilkins, Javier Vilar, Macpherson Mallewa, Dominic Doran, David Back and Munir Pirmohamed

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 62, issue 4, pages 648-660
Published in print October 2008 | ISSN: 0305-7453
Published online June 2008 | e-ISSN: 1460-2091 | DOI: https://dx.doi.org/10.1093/jac/dkn251
HIV-associated lipodystrophy: a review of underlying mechanisms and therapeutic options

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Lipodystrophy (LD) is a common adverse effect of HIV treatment with highly active antiretroviral therapy, which comprises morphological and metabolic changes. The underlying mechanisms for LD are thought to be due to mitochondrial toxicity and insulin resistance, which results from derangements in levels of adipose tissue-derived proteins (adipocytokines) that are actively involved in energy homeostasis. Several management strategies for combating this syndrome are available, but they all have limitations. They include: switching from thymidine analogues to tenofovir or abacavir in lipoatrophy, or switching from protease inhibitors associated with hyperlipidaemia to a protease-sparing option; injection into the face with either biodegradable fillers such as poly-l-lactic acid and hyaluronic acid (a temporary measure requiring re-treatment) or permanent fillers such as bio-alcamid (with the risk of foreign body reaction or granuloma formation); and structured treatment interruption with the risk of loss of virological control and disease progression. There is therefore a need to explore alternative therapeutic options. Some new approaches including adipocytokines, uridine supplementation, glitazones, growth hormone (or growth hormone-releasing hormone analogues), metformin and statins (used alone or in combination) merit further investigation.

Keywords: adipocytokines; antiretroviral therapy; protease inhibitors; nucleoside reverse transcriptase inhibitors

Journal Article.  8101 words. 

Subjects: Medical Oncology ; Critical Care

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