The metabolic toxicities of antiretroviral therapy

Since the adoption of highly active antiretroviral therapy (HAART) in the m id-1990s, certain metabolic toxicities have been increasingly recognized. T hese include a fat redistribution syndrome (lipohypertrophy, lipoatrophy), hyperlipidaemia, altered glucose metabolism and insulin resistance, mitocho ndrial toxicity (presenting as anaemia, myopathy, pancreatitis, neuropathy, hepatic steatosis and lactic acidosis), and bone density abnormalities (os teoporosis and osteonecrosis). Metabolic complications are principally repo rted with protease inhibitors and nucleoside reverse transcriptase inhibito rs, but may be seen with all classes of antiretroviral therapy. In this rev iew, we summarize the epidemiology, pathogenesis and management of these va rious toxicities.