Current Concepts in the Diagnosis and Management of Metabolic Complications of HIV Infection and Its Therapy

Abstract

Changes in fat distribution, dyslipidemia, disordered glucose metabolism, and lactic acidosis have emerged as significant challenges to the treatment of human immunodeficiency virus (HIV) infection. Over the past decade, numerous investigations have been conducted to better define these conditions, identify risk factors associated with their development, and test potential therapeutic interventions. The lack of standardized diagnostic criteria, as well as disparate study populations and research methods, have led to conflicting data regarding the diagnosis and treatment of metabolic and body shape disorders associated with HIV infection. On the basis of a review of the medical literature published and/or data presented before April 2006, we have prepared a guide to assist the clinician in the detection and management of these complications.

Prevalence of and Clinical Factors Associated with Lipoatrophy in HIV-Infected Koreans Receiving Highly Active Antiretroviral Therapy

“…Diagnosis of lipoatrophy was based upon the concordance between lipodystrophy-specific physical examination and history taking performed by a single physician (Carr et al 2003;Milinkovic and Martinez 2005;Estrada et al 2006;Wohl et al 2006;van Griensven et al 2007;Wierzbicki et al 2008). The physician made the detailed examination for the morphological changes by noting subcutaneous fat loss in the face, buttocks and upper or lower extremities, such as wasting and vascular prominence in the extremities, hollowing of the cheeks or flattening of the buttocks (Carr et al 2003;van Griensven et al 2007).…”

“…Lipoatrophy and lipohypertrophy are thought to occur independently from each other and to have different risk factors (Jacobson et al 2005;Wohl et al 2006;Waters and Nelson 2007;Brown 2008;Wierzbicki et al 2008). Because two phenomena are distinct processes, it should be considered separately rather than collectively as a single syndrome of lipodystrophy (Brown 2008).…”

Lipodystrophy in HIV 1-infected patients: lessons for obesity research

“…The molecular basis of this syndrome is not fully understood, but intensive research in recent years has revealed multiple aspects of adipose tissue physiopathology that were previously unsuspected, and HALS research has highlighted novel aspects of adipose tissue that are highly relevant to other diseases such as obesity and lipodystrophies of genetic origin. Many available reviews cover the clinical aspects of HALS, 1,2 extensive description of the cellular and molecular alterations associated with the syndrome 3 and its potential management. 4 The present review is focused specifically on summarizing how the information obtained from HALS research contributes to our knowledge of novel aspects of adipose tissue biology which may be relevant to obesity research.…”

A retrospective analysis of dysglycaemia and its risk factors in a cohort of human immunodeficiency virus infected antiretroviral therapy naïve children in Makurdi, Nigeria

“…Wohl et al 42 had also mentioned hepatitis C infection as a risk factor for hyperglycaemia among HIV-infected adults. The pathophysiology of hyperglycaemia in hepatitis C infection is not completely understood.…”