Management of the metabolic effects of HIV and HIV drugs

Brown, Todd T.; Glesby, Marshall J.

doi:10.1038/nrendo.2011.151

Cited by 59 publications

(43 citation statements)

References 164 publications

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“…Many patients had developed resistances and were receiving antiretroviral rescue therapy, including d4T. Our fi ndings support the notion that d4T should be avoided whenever possible in HIV-infected patients, and confi rm that it is a signifi cant risk factor for metabolic disorders and abnormal fat distribution (22,25) .…”

Section: Discussionsupporting

confidence: 80%

Metabolic disorders in vertically HIV-infected children: future adults at risk for cardiovascular disease

Dapena¹,

Jiménez²,

Noguera-Julián

et al. 2012

Journal of Pediatric Endocrinology and Metabolism

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Background: Despite metabolic disorders in HIV-infected children being widely described, there is still a lack of agreed criteria for diagnoses and management. Numerous studies are coming from other settings and results are heterogeneous when assessing several analytical and clinical parameters. Objectives: To describe the prevalence of metabolic disorders and associated risk factors in the Spanish National cohort of HIV-infected pediatric patients (CoRISpe). Methods: This was a cross-sectional study following all vertically HIV-infected children and adolescents in three referral centers included in the CoRISpe. Metabolic data (fasting lipids, glucose and insulin levels and thyroid hormone levels) were collected. Fat distribution was clinically assessed by expert clinicians. Results: We included 157 patients [median age 13 years, interquartile range (IQR) 10 -16]. Median duration of antiretroviral therapy was 10.2 years (IQR 5.0 -13.0). Almost 20 % of patients had insulin resistance and this was associated with hepatitis C co-infection, current use of stavudine (d4T) and hypertriglyceridemia. Hypercholesterolemia and hypertriglyceridemia were found in 23.9 % and 24.8 % of patients and were associated with current use of protease inhibitors (p = 0.042 and p = 0.022, respectively). Abnormal fat

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Section: Discussionsupporting

confidence: 80%

Metabolic disorders in vertically HIV-infected children: future adults at risk for cardiovascular disease

Dapena¹,

Jiménez²,

Noguera-Julián

et al. 2012

Journal of Pediatric Endocrinology and Metabolism

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“…Many biologic factors are known or assumed to contribute to the development of frailty, including chronic inflammation (as measured by IL-6 and other biomarkers), hypercoagulability, mitochondria dysfunction, DNA mutagenesis, alterations in telomerase activity/telomere length phenotype and endocrinopathies(62). HIV infection and its treatment impacts in a potential detrimental manner all of these pathways(20, 35, 63-65). A highly contentious issue ripe for future mechanistic studies is whether there are distinct aspects of HIV disease that alters the biology of aging in some fundamental manner (64, 66).…”

Section: Does Hiv Infection Accelerate Aging?mentioning

confidence: 99%

The end of AIDS: HIV infection as a chronic disease

2013

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Antiretroviral therapy has been a spectacular success. People are now asking if the end of AIDS is possible. For those who are motivated to take therapy and who have access to lifelong treatment, AIDS-related illnesses are no longer the primary threat, but a new set of HIV-associated complications have emerged, resulting in a novel chronic disease that for many will span several decades of life. Treatment does not fully restore immune health; as a consequence, a number of inflammation-associated and/or immunodeficiency complications such as cardiovascular disease and cancer are increasing in importance. Cumulative toxicities from exposure to antiretroviral drugs for decades cause clinically-relevant metabolic disturbances and end-organ damage. There are growing concerns that the multi-morbidity associated with HIV disease may impact healthy aging and could overwhelm some health care systems, particularly those in resource-limited regions that have yet to fully develop a chronic care model. Given the problems inherent in treating and caring for a chronic disease that might persist for several decades, a global effort to identify a cure is now underway.

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“…For example, avoidance of some ART regimens, containing stavudine and zidovudine, might help in preventing the development of lipoatrophy, but no strategies have proven effective against lipohypertrophy[255]. For patients with established lipoatrophy, switching from ART regimens, containing either stavudine or zidovudine, to an alternative ART regimen could be an empirical choice.…”

Section: Hiv Infectionmentioning

confidence: 99%

Fatty liver is associated with an increased risk of diabetes and cardiovascular disease - Evidence from three different disease models: NAFLD, HCV and HIV

Lonardo¹,

Ballestri²,

Guaraldi³

et al. 2016

WJG

105

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Fatty liver, which frequently coexists with necro-inflammatory and fibrotic changes, may occur in the setting of nonalcoholic fatty liver disease (NAFLD) and chronic infections due to either hepatitis C virus (HCV) or human immunodeficiency virus (HIV). These three pathologic conditions are associated with an increased prevalence and incidence of cardiovascular disease (CVD) and type 2 diabetes (T2D). In this multidisciplinary clinical review, we aim to discuss the ever-expanding wealth of clinical and epidemiological evidence supporting a key role of fatty liver in the development of T2D and CVD in patients with NAFLD and in those with HCV or HIV infections. For each of these three common diseases, the epidemiological features, pathophysiologic mechanisms and clinical implications of the presence of fatty liver in predicting the risk of incident T2D and CVD are examined in depth. Collectively, the data discussed in this updated review, which follows an innovative comparative approach, further reinforce the conclusion that the presence of fatty/inflamed/fibrotic liver might be a shared important determinant for the development of T2D and CVD in patients with NAFLD, HCV or HIV. This review may also open new avenues in the clinical and research arenas and paves the way for the planning of future, well-designed prospective and intervention studies.

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Management of the metabolic effects of HIV and HIV drugs

Cited by 59 publications

References 164 publications

Metabolic disorders in vertically HIV-infected children: future adults at risk for cardiovascular disease

Metabolic disorders in vertically HIV-infected children: future adults at risk for cardiovascular disease

The end of AIDS: HIV infection as a chronic disease

Fatty liver is associated with an increased risk of diabetes and cardiovascular disease - Evidence from three different disease models: NAFLD, HCV and HIV

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