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Peripheral lipodystrophy and metabolic disorders in HIV infection |
Sang Thrombose Vaisseaux. Volume 11, Number 10, 753-60, Décembre 1999, Mini-revues
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 Résumé
Article gratuit
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Author(s) : Sophie Morelon, Caroline Dupont, Marie-Laure Raffin-Sanson |
Summary : Over the last two years, abnormal body fat distribution and changes in lipid and carbohydrate metabolism have been observed in HIV 1 infected patients, sometimes associated with severe and early coronary artery disease. These abnormalities essentially occur in patients receiving highly active antiretroviral therapies. The so-called “lipodystrophy” includes various degrees of central visceral fat accumulation, fat deposition in the breasts and the dorsocervical spine, and peripheral fat wasting (limbs and face). In some patients, wasting is the predominant feature; in others, increased adiposity of the trunk prevails. Hypertriglyceridemia or combined hyperlipidemia and insulin resistance may be associated with fat redistribution or may occur in isolation. Diabetes is unfrequent. The prevalence of this syndrome varies widely, according to the studies, from 12 to 83%. The cause(s) of the syndrome(s) is unknown. Antiretrovial therapies are most probably involved, but also HIV infection itself or modifications of immunity play a role. Factors independently correlated with the risk of fat redistribution are a longer duration of antiretroviral therapy, the use of protease-inhibitors and/or 3TC and a high initial viral load. The consequences of these syndromes are psychological (aesthetic alteration of body shape) and pancreatic (in cases of severe hypertriglyceridemia). Moreover, early acute vascular events (mostly related to coronary artery disease) have also been reported in patients given antiretroviral drugs. Therapy for metabolic abnormalities is mostly grounded on dietary counselling; the safety and efficacy of lipid and glucose lowering drugs has to be assessed. At present, no specific treatment is available for the correction of fat redistribution. |
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