Antiretroviral Therapy-Associated Metabolic Complications: Review of the Recent Studies (original) (raw)
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HIV medications: an update and review of metabolic complications
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2012
In the past 30 years, medical advances for those with human immunodeficiency virus (HIV) have reduced morbidity and mortality to extend life with highly active antiretroviral therapy (HAART) and with the continued development of new therapies. With this success, HIV is being managed chronically, but other health issues of an aging HIV-infected population have emerged. The challenges of treating HIV infection have shifted from AIDS-related mortality improvements to drug-induced disease from HAART, including cardiovascular disease, metabolic disorders, and bone health. Prolonged use of antiretroviral therapy maintaining immune restoration appears to represent additional, ongoing risk factors for the development of these metabolic complications. These drug-related problems continue to challenge patients and clinicians in the management of HIV disease, as well as ongoing research for drug development improvements to minimize these risks. These health risks imposed by HAART must be vigil...
HIV, Antiretroviral Therapy and Metabolic Alterations: A Review
Cureus
The introduction of antiretroviral therapy (ART) has caused some metabolic problems to people who suffer from HIV. ART probably is not the sole reason for these metabolic disorders. Most likely, HIV itself affects the metabolism as well. We conducted research to find the prevalence of the different types of metabolic disorders among HIV(+) patients. Female gender, high BMI, and older age are among the risk factors for the occurrence of metabolic disorders. Regarding dyslipidemia, hypertriglyceridemia and low high-density lipoproteins (HDLs) are the most common types of dyslipidemia in the studies we included. Protease inhibitors (PIs) are widely known as the most common class of antiretroviral drugs that cause metabolic disorders, and some studies in our review also demonstrated this knowledge. In our review, we concluded that HIV and ART concurrently alter the metabolism, but further research is required about this substantial topic.
Ethiopian medical journal, 2012
Highly active antiretroviral therapy (HAART) improves the longevity of HIV patients. However, the side effect of the drugs leads to development of chronic metabolic and cardiovascular complications. The aim of the study was to determine the prevalence and risk factors of the metabolic abnormalities and lipodystrophy among adult Ethiopian HIV infected patients on ART for one year and above. A cross-sectional study was conducted among HIV infected patients on HAART for one year or more, attending the ART clinics of Tikur Anbessa Specialized hospital in Addis Ababa. A total of consecutive 356 HIV infected patients volunteered to participate in the study from July 2007 to January 2008. Data was collected using clinical interview technique on structured questionnaires and physical examination of the patient, 319 had biochemical tests performed. Three hundred fifty six HIV patients; 261 (73.1%) females and 95 (26%) males were studied. Two hundred nine (59.7%) patients were on Stavudine ba...
Association of Highly Active Antiretroviral Treatment for HIV Disease and Metabolic Issues
Academic Journal of Interdisciplinary Studies, 2015
said by the most current medical principles. Aim/methods: The aim of this review is to investigate the metabolic problems of treatments used to cure HIV infection. Results: They imply that HAART-linked lipodystrophy may be the outcome of adipocyte alteration engaging changeable mixtures of apoptosis, imperfect lipogenesis, and amplified metabolic action in diverse adipose body regions. In this survey, multivariate analysis made known that, between the inspected parameters, apo C-III was the single element powerfully connected with the incidence of lipodystrophy. Conclusion: Fat relocation may lead the progress of metabolic barriers in HIV-contaminated subjects getting HAART. The strictness of these metabolic deviations enhances with rising harshness of lipodystrophy, and they are related with an elevated threat of cardiovascular incidents: around 1.4 cardiac episodes per 1000 years of treatment regarding the Framingham result. Even if several surveys have revealed that the consume of glitazones for the cure of HIV-related lipodistrophy leads to an improvement in insulin resistance, contrasting results propose that additional labor is required .
Introduction: metabolic dysfunctions, such as diabetes and dyslipidemia (DLP), are frequent alterations in HIV-infected patients on antiretroviral therapy (ART), which leads to a higher risk of developing cardiovascular diseases. The present study aims to evaluate the ART regimens and other variables as risk factors for the onset of these metabolic disorders. Material and methods: 263 HIV-positive patients were evaluated at the Specialized Care Service in the city of São José do Rio Preto, Brazil, and these were divided according to the presence or absence of dysglycemia and DLP. Results: no significant difference was found in the evaluation for the risk of dysglycemia and DLP according to the ART regimen. The dysglycemic group presented a higher mean age and a higher family history of diabetes and lipodystrophy, in a significant way. Thyroid dysfunctions were higher in the euglycemic group. The dyslipidemic group had more significant female individuals. Thyroid dysfunctions were more frequent in the non-DLP group. Conclusion: unlike other studies, ART regimens did not present a significant difference for the onset of diabetes or DLP. Other risk factors for the development of these metabolic diseases in HIV-positive patients need to be better evaluated.
Metabolic Disorders in Patients with HIV
Romanian Journal of Diabetes Nutrition and Metabolic Diseases, 2016
Human Immunodeficiency Virus (HIV) infection and subsequent antiretroviral therapy (ART) are known to be related to different metabolic disorders. Although ART decreased HIV-associated mortality and morbidity, mortality rates in patients with HIV and ART are 3 to 15 higher than those in the general population. More than 50% of the mortality is due to diseases like: diabetes mellitus (DM), hypertension, cardiovascular diseases (CVD), chronic renal disease and complications following bone fractures. In patients with HIV the metabolic disorders are mainly caused by mithocondrial toxicity, a side effect of ART, and they are represented by: dyslipidemia, lipoatrophy, insulin resistance and diabetes mellitus.
Considering metabolic issues when initiating HIV therapy
Current HIV/AIDS Reports, 2007
Patients with HIV infection and their clinicians are increasingly considering the risk of metabolic complications when choosing HIV therapies. Fear of the potential metabolic consequences of antiretroviral agents may lead some to delay HIV therapy and threaten medication adherence once treatment is initiated. Until recently, there has been limited objective study of the relative contributions of specific antiretrovirals and particular combinations of these drugs to dyslipidemia and body fat changes; in lieu of data, unsupported perceptions regarding the links between therapies and these metabolic complications have predominated. Over the past year, a number of comparative clinical trials have clarified the association between exposure to antiretrovirals and lipid and fat disorders and, in some cases, have yielded results that challenge our perceptions regarding the causes of these complications.
Update on metabolic issues in HIV patients
Current Opinion in HIV and AIDS, 2014
Purpose of review To report on the recent advances on lipids, diabetes, and body fat in HIV-infected patients from the perspective of aging. Recent findings HIV infection causes microbial translocation and inflammation that contribute to hypertriglyceridemia and insulin resistance, and quantitative and qualitative HDL-cholesterol changes that further contributes to atherosclerosis. These changes are incompletely reversed by antiretroviral therapy. Protease inhibitors have the worse lipid profile among the currently used antiretroviral drugs. Etravirine, maraviroc, and raltegravir have a lipid impact better than other antiretroviral classes. The importance of genetic background on dyslipidemia of HIV-infected patients is becoming increasingly known. Lipodystrophy is associated with inflammation, dyslipidemia, diabetes, hypertension, and functional decline. Lipohypertrophy is becoming more common in HIV-infected patients influenced by the current obesity epidemics in the general population. Summary Inflammation, cholesterol abnormalities, and lipodystrophy caused by both HIV infection and antiretroviral therapy may pose aging HIV-infected patients at a higher risk of comorbidities and frailty despite sustained viral suppression. Healthier lifestyles and strategies specifically addressed to diminish the impact of these pathophysiologic abnormalities will be needed for preserving the overall health in aging HIV-infected persons.
ISRN AIDS, 2012
Introduction. While the introduction of highly active antiretroviral therapy decreased HIV-related morbidity and mortality rates in the sub-Saharan Africa, a subsequent increase in metabolic abnormalities has been observed. We sought to determine the prevalence of HIV-associated metabolic abnormalities among patients on first-line antiretroviral therapy (ART) in an ART clinic in Kampala, Uganda. Methods. Four hundred forty-two consecutive patients on first-line ART for at least 12 months were screened for eligibility in a cross-sectional study, and 423 were enrolled. Pre-ART patient characteristics were abstracted from medical charts, examinations included anthropometric measurement and physical assessment for lipodystrophy. Results. The prevalence of hyperglycemia and dyslipidemia was 16.3% (69/423) and 81.5% (345/423), respectively. Prevalence of dyslipidemia between stavudine-and zidovudine-based regimens (91% versus 72%; P < 0.001). Being on stavudine (aOR 4.79, 95%, 2.45-9.38) and peak body weight (aOR 1.44, 95% CI 1.05-1.97) were independent risk factors for dylipidemia. Stavudine (aOR 0.50, 95% CI 0.27-0.93) use was associated with lower risk for hyperglycemia while, and older age (aOR 1.31, 95% CI 1.11-1.56) and having a family history of DM (aOR 2.18, 95% CI 1.10-4.34) were independent risk factors for hyperglycemia. Conclusions. HIV-associated metabolic complications were prevalent among patients on thymidine analogue-containing ART regimens. Screening for lipid and glucose abnormalities should be considered in ART patients because of cardiovascular risks.