The metabolic puzzle during the evolution of HIV infection

Abnormalities in energy, protein, lipid and glucose metabolism have been de scribed in HIV patients since the beginning of the epidemic. With the new a ntiretroviral agents, nutritional status and survival have improved dramati cally. However; since these therapies were introduced, there have been more descriptions of metabolic abnormalities, some of which were similar to and others of which were in conflict with those reported in previous years. Th is paper reviews the complexity of the metabolic abnormalities in HIV infec tions before and after the introduction of highly active antiretroviral the rapy, and discusses such etiopathogenic mechanisms as secondary infections, antiretroviral drugs and persistent immune activation, which may be involv ed in these derangements. (C) 2001 Harcourt Publishers Ltd.