Abstract
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.
Highlights
The success of controlling HIV infection with antiretroviral drugs (ARVs) and the resultant reduction in morbidity and mortality has been marred somewhat by the development of significant adverse effects in some patients, which include metabolic and morphological changes
The role of adipocytokines in the pathogenesis of LD is well understood, and research into the use of adipocytokines such as leptin shows promising results, but more research needs to be performed to look at other cytokines such as adiponectin and visfatin
Glitazones, statins, growth hormone (GH) and its secretagogues as well as uridine do provide some benefit in HIV LD, though their use has some undesirable effects
Summary
The success of controlling HIV infection with antiretroviral drugs (ARVs) and the resultant reduction in morbidity and mortality has been marred somewhat by the development of significant adverse effects in some patients, which include metabolic and morphological changes. Studies with TNF-a antagonists designed to improve insulin sensitivity have not been promising in humans with obesity and
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