HIV lipodystrophy

Česká verzia

Authors: S. Snopková ¹; M. Matýšková ²; K. Povolná ¹; P. Polák ¹; P. Husa ¹
Authors place of work: Klinika infekčních chorob Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Petr Husa, CSc. 2 Oddělení klinické hematologie FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Miroslav Penka, CSc. ¹
Published in the journal: Vnitř Lék 2010; 56(12): 1217-1222
Category: Reviews

Summary

Combined antiretroviral therapy results in extraordinary decrease of morbidity and mortality of HIV- infected patients and in an essential change of the HIV/ AIDS disease prognosis. However, long‑term intake of antiretroviral medicaments is related to occurrence of metabolic and morphological abnormalities, of which some have been combined into a new syndrome – the so called HIV lipodystrophy. The HIV lipodystrophy syndrome covers metabolic and morphological changes. Metabolic changes include dyslipidaemia with hypercholesterolaemia and/ or hypertriglyceridaemia, insulin resistance with hyperinsulinaemia and hyperlaktataemia. Morphological changes have the nature of lipoatrophia (loss of subcutaneous fat – on the cheeks, on extremities, on buttocks and marked prominence of surface veins) or lipohypertrophia (growth of fat tissue – on the chest, in the dorsocervical area, lipomatosis of visceral tissues and organs, fat accumulation in the abdominal area). Several HIV lipodystrophy features are very similar to the metabolic syndrome of the general population. That is why this new syndrome represents a prospective risk of premature atherosclerosis and increase of the cardiovascular risk in young HIV positive individuals. The article mentions major presented studies dealing with the relation of antiretroviral treatment and the cardiovascular risk. The conclusions of the studies are not unequivocal – this is, among others, given by the reason that their length is short from the viewpoint of atherogenesis. The major risk of subclinical atherosclerosis acceleration seems to be related to the deep immunodeficiency and low number of CD4⁺ lymphocytes and florid, uncontrolled HIV infection with a high number of HIV‑ 1 RNA copies actually circulating in the plasma. The question, whether metabolic and morphological changes related to HIV and cART carry a similar atherogenic potential as in the general population, remains open for future.

Key words:
antiretroviral therapy – HIV lipodystrophy – atherogenesis – cardiovascular risk

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