Fat distribution and metabolic changes in patients with HIV infection

Safrin, Sharon; Grünfeld, Carl

doi:10.1097/00002030-199912240-00002

Cited by 344 publications

(193 citation statements)

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“…For example, HIV infection may cause dyslipidemia in the absence of therapy. 3 Thus, how PIs interact with infection to alter lipid metabolism is unclear. Nonetheless, this study provides experimental evidence that serves to explain the elevation in serum TG levels observed in patients who receive PI therapy in the clinic; in particular, the results suggest that select PIs stimulate TG synthesis in hepatocytes.…”

Section: Discussionmentioning

confidence: 99%

“…1 HAART has been associated with numerous affects on lipid metabolism, including subcutaneous fat wasting, abdominal obesity, insulin resistance, and hyperlipidemia. 2,3 Metabolic complications arising from HAART may be due to drug-drug interactions, exacerbation of preexisting conditions, reconstitution of immune system function, or a combination. 2,3 Studies of hyperlipidemia in HIV-infected persons are complicated because dyslipidemia may occur in the absence of therapy (reviewed in Safrin and Grunfeld 3 ).…”

mentioning

confidence: 99%

“…2,3 Studies of hyperlipidemia in HIV-infected persons are complicated because dyslipidemia may occur in the absence of therapy (reviewed in Safrin and Grunfeld 3 ). Although HIV infection itself and treatment with reverse transcriptase inhibitors have been associated with altered metabolism, [2][3][4][5][6] substantial evidence indicates a role for some PIs in causing metabolic complications.…”

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confidence: 99%

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HIV Protease Inhibitors Stimulate Hepatic Triglyceride Synthesis

Lenhard

Croom

Weiel

et al. 2000

ATVB

134

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Abstract-Hyperlipidemia may complicate the use of HIV protease inhibitors (PIs) in AIDS therapy. To determine the cause of hyperlipidemia, the effect of PIs on lipid metabolism was examined with HepG2 liver cells and AKR/J mice. In HepG2 cells, the PIs ABT-378, nelfinavir, ritonavir, and saquinavir stimulated triglyceride synthesis; ritonavir increased cholesterol synthesis; and amprenavir and indinavir had no effect. Moreover, nelfinavir increased mRNA expression of diacylglycerol acyltransferase and fatty acid synthase. The retinoid X receptor agonist LG100268, but not the antagonist LG100754, further increased PI-stimulated triglyceride synthesis and mRNA expression of fatty acid synthase in vitro. In fed mice, nelfinavir or ritonavir did not affect serum glucose and cholesterol, whereas triglyceride and fatty acids increased 57% to 108%. In fasted mice, ritonavir increased serum glucose by 29%, cholesterol by 40%, and triglyceride by 99%, whereas nelfinavir had no effect, suggesting these PIs have different effects on metabolism. Consistent with the in vitro results, nelfinavir and ritonavir increased triglyceride 2-to 3-fold in fasted mice injected with Triton WR-1339, an inhibitor of triglyceride clearance. We propose that PI-associated hyperlipidemia is due to increased hepatic triglyceride synthesis and suggest that retinoids or meal restriction influences the effects of select PIs on lipid metabolism. HAART has been associated with numerous affects on lipid metabolism, including subcutaneous fat wasting, abdominal obesity, insulin resistance, and hyperlipidemia. 2,3 Metabolic complications arising from HAART may be due to drug-drug interactions, exacerbation of preexisting conditions, reconstitution of immune system function, or a combination. 2,3 Studies of hyperlipidemia in HIV-infected persons are complicated because dyslipidemia may occur in the absence of therapy (reviewed in Safrin and Grunfeld 3 ). Although HIV infection itself and treatment with reverse transcriptase inhibitors have been associated with altered metabolism, 2-6 substantial evidence indicates a role for some PIs in causing metabolic complications.PIs are important therapeutically because they inhibit virus release from infected cells, reducing virus proliferation and subsequent infection. 7 The currently available PIs include amprenavir (APV), indinavir (IDV), nelfinavir (NFV), ritonavir (RTV), saquinavir (SQV), and ABT-378 (lopinavir; delivered in combination with RTV to enhance systemic exposure to ABT-378). The antiviral activity among individual PIs is variable and correlates with the ability to inhibit the HIV protease (ie, IC 50 0.10 to 20 nmol/L). Although these drugs contain a synthetic analog of the phenylalanine-proline amino acid sequence cleaved by the HIV protease, structural differences result in unique resistance and metabolic effects for each PI. 7 Initial reports in 1997 indicated that a number of patients developed hyperlipidemia after PI therapy. Several studies specifically implicated RTV, RTV/SQV, or NFV thera...

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Section: Discussionmentioning

confidence: 99%

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HIV Protease Inhibitors Stimulate Hepatic Triglyceride Synthesis

Lenhard

Croom

Weiel

et al. 2000

ATVB

134

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“…A síndrome lipodistrófica em pessoas soropositivas para o HIV é uma condição progressiva, cuja severidade parece diretamente proporcional ao tempo de tratamento com medicação anti-retroviral (Safrin & Grunfeld, 1999). As mudanças corporais têm sido relacionadaa à lipohipertrofia (aparecimento de gordura dorsocervical, expansão da circunferência do pescoço, aumento do volume dos seios e acúmulo de gordura na região abdominal) e à lipoatrofia (diminuição de gordura periférica, com perda de tecido subcutâneo na face, braços, pernas e nádegas).…”

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“…As mudanças corporais têm sido relacionadaa à lipohipertrofia (aparecimento de gordura dorsocervical, expansão da circunferência do pescoço, aumento do volume dos seios e acúmulo de gordura na região abdominal) e à lipoatrofia (diminuição de gordura periférica, com perda de tecido subcutâneo na face, braços, pernas e nádegas). A lipodistrofia também tem sido associada a alterações no metabolismo glicêmico, resistência insulínica e dislipidemia (Safrin & Grunfeld, 1999;Valente, Reis, Machado, Succi & Chacra, 2005).…”

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Bem-estar psicológico, enfrentamento e lipodistrofia em pessoas vivendo com HIV/AIDS

Seidl¹,

Machado²

2008

Psicol. estud.

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RESUMO.Os objetivos do estudo foram investigar os efeitos da lipodistrofia sobre o bem-estar psicológico e a adesão ao tratamento anti-retroviral, e identificar as estratégias de enfrentamento utilizadas por pessoas soropositivas afetadas pela síndrome. Participaram 21 pessoas, com idades entre 29 e 52 anos, das quais quatorze eram homens. As entrevistas foram analisadas com base na análise de conteúdo categorial. Os resultados apontaram que a descoberta e a vivência da lipodistrofia podem afetar o bem-estar psicológico, ocasionando redução da auto-estima, percepção negativa da imagem corporal e evitação de contatos sociais. Não se observou impacto negativo sobre a conduta de adesão. As estratégias de enfrentamento relatadas com maior freqüência foram: prática de atividade física, uso de roupas que escondam as mudanças corporais, realização de procedimentos estéticos e adoção de novos hábitos alimentares. Conclui-se que a ocorrência da lipodistrofia pode acarretar dificuldades psicológicas, merecendo atenção das equipes de saúde que atuam em HIV/aids.. Palavras-chave:pessoas vivendo com HIV/aids, lipodistrofia, bem-estar psicológico. PSYCHOLOGICAL WELL-BEING, COPING AND LIPODYSTROPHY IN HIV/AIDS PEOPLEABSTRACT. The study investigates the effects of the HIV lipodystrophy syndrome on the psychological well-being and on the adherence to anti-retroviral treatment. It also identifies the coping strategies used. Twenty-one people, age bracket 29 -52 years old, including fourteen males, took part in the research. Data procedures included structured and semi-structured interview. Results showed that disclosure of lipodystrophy may affect the psychological well-being, leading towards a decrease in self-esteem, negative perception of body image and avoidance of social relationships. The most related coping strategies consisted of practice of physical activities, usage of clothing which can hide body changes, realization of esthetic procedures and the adoption of new feeding habits. Results show that lipodystrophy experience may cause relevant emotional and psychological difficulties to affected people. This fact suggests that it should be given more attention to health professionals who deal with HIV/AIDS. Key words:Persons living with HIV/AIDS, lipodystrophy, psychological well-being. BIENESTAR PSICOLÓGICO, AFRONTAMIENTO Y LIPODISTROFIA EN PERSONAS QUE VIVEN CON VIH/SIDARESUMEN. Los objetivos del estudio fueron explorar los efectos de la lipodistrofia en el bienestar psicológico, la adhesión al tratamiento antirretroviral, bien como identificar las estrategias de afrontamiento utilizadas por personas soropositivas con lipodistrofia. Participaran de la investigación 21 personas, con edades entre 29 y 52 años, catorce hombres. El análisis de las entrevistas siguió la técnica de análisis de contenido categorial. Los resultados indican que la descubierta y vivencia de la lipodistrofia pueden afectan el bienestar psicológico, lo que ocasiona reducción en la autoestima, percepción negativa de la imagen corporal y evitación de ...

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