Pathway of Metabolic Syndrome in HIV Lipodystrophy

Lipodystrophy, the redistribution of fat around the body, occurs frequently in advanced HIV disease. It is now understood that this part of a larger issue known as HIV lipodystrophy syndrome (HLS), which is a form of metabolic syndrome. The effects of HLS can impact multiple body systems. Although the full pathway of HLS has not been uncovered, it is thought that it is largely related to antiretroviral therapy used in the treatment of HIV disease.

Types

• Many different classes of drugs are used in the management of HIV. At least two of these, protease inhibitors and thymidine analogues, also known as nucleoside analog reverse transcriptase inhibitors, have been identified as playing a role in HIV lipodystrophy syndrome, according to Dr. Jacqueline Capeau. These medications may work on fat tissue, causing the loss of fat, according to Capeau.

Mechanism

• Antiretroviral therapy affects fat cells in a number of ways. These medications can cause problems in developing fat cells by interfering with protein production and causing insulin resistance and cell death in mature fat cells.

Effects

• The effects of antiretroviral drugs on fat cells lead the body to overly rapidly break down fats, according to Dr. Rajagopal Sekhar. This fat then concentrates in the liver and the blood, thus raising fat levels found in the blood, according to Sekhar.

Risks

• Increased circulating fat in HIV lipodystrophy impacts the life of an HIV-positive person on antiretroviral therapy in many ways. In addition to changing the appearance, Sekhar reports that affected people may have abdnominal pain, trouble breathing, hernias, gastroesophageal reflux and increased risk for heart disease.

Considerations

• Medications that decrease the rate of fat breakdown in the body may offer hope to people suffering from HIV lipodystrophy syndrome, according to Sekhar. Capeau also suggests, when possible, using antiretroviral drugs that are known to have a less severe impact on metabolism.