Lipodystrophy syndrome in HIV infection - What is it, what causes it and how can it be managed?

Since the introduction of HIV-1 protease inhibitors as components of antire troviral drug combination regimens, the clinical course of HIV disease and opportunistic infections has changed dramatically, Besides the favourable v irological, immunological and clinical impact of highly active antiretrovir al therapy (HAART). several adverse drug reactions have been observed in pa tients with HIV receiving therapy, Particularly, peripheral lipodystrophy, central adiposity, dyslipidaemia and insulin resistance have been described with a prevalence of up to 80% in patients infected with HIV, and attribut ed to almost all components of HAART. Hyperlipidaemia is characterised by a n increase of low and very low density lipoprotein-cholesterol as well as a polipoproteins B and E. Several studies strongly suggest that then are eith er multiple syndromes or a variety of factors inducing different changes th at influence the ultimate phenotype. Similarities between HIV-associated fa t redistribution and metabolic abnormalities with both inherited Iipodystro phies and benign symmetric lipomatosis suggest the pathophysiological invol vement of, for example, nuclear factors like lamin A/C and drug-induced mit ochondrial dysfunction. Moreover, there is some evidence that cytokines and hormones impair fat and glucose homeostasis in patients with HIV receiving HAART. Three years after the first description of HIV therapy-associated a bnormal fat redistribution, there is still an ongoing discussion about the case definition, diagnostic procedure and treatment options for both body s hape changes and metabolic disturbances. Regarding therapy, there is a majo r concern about possible complex pharmacological interactions and overlappi ng adverse effects between HAART and, for example, lipid-lowering therapy. In addition, the likely contribution of both nucleoside analogue reverse tr anscriptase inhibitors and protease inhibitors to the development of abnorm al fat redistribution in patients with HN Limits options of changing to alt ernative effective antiretroviral drug combinations. Thus, the occurrence o f hyperlipidaemia, maturity onset diabetes mellitus, and marked changes in body habitus resulted in important social and clinical consequences such as an increased risk of atherosclerosis. It also sheds new Light on the use o f protease inhibitors regarding risk factors for the initial treatment deci sion. In this article, we discuss the features, pathogenesis and treatment options for body fat redistribution and metabolic disturbances associated w ith HAART in HIV-1 infection.