Hardy H, Esch L D, Morse G D
Infectious Diseases, New England Medical Center, Boston, MA, USA.
Ann Pharmacother. 2001 Mar;35(3):343-51. doi: 10.1345/aph.10044.
To review the impact that factors such as HIV infection, antiretrovirals, and other commonly used drug therapies have on glucose metabolism in HIV-infected patients.
Pertinent literature was identified via a MEDLINE search from 1980 to April 2000 and through secondary sources (abstracts presented at recent scientific meetings, manufacturers' package inserts). The key words used were antiretroviral therapy, HIV infection, insulin resistance, and metabolic abnormalities. All information deemed relevant to evaluate the impact that HIV infection and drug therapy have on glucose metabolism in HIV-infected patients was included.
The viral burden and stress that are present in HIV-infected patients elicit a complex hormonal and immunologic response that may alter various biochemical pathways, including glucose metabolism. Although rare before the era of potent antiretroviral therapy, insulin resistance has now been described as an important component of the lipodystrophy syndrome. The complex and multifactorial nature of glucose metabolism dysregulation makes management of hyperglycemia or diabetes mellitus challenging in HIV-infected patients. In such a context, a set of recommendations was developed to guide practitioners in assessing, treating, and monitoring hyperglycemia or diabetes mellitus in HIV-infected patients.
Alterations of glucose metabolism observed in HIV-infected patients are more frequent since the introduction of potent antiretroviral therapy. Although the etiology of such abnormalities remains unknown, protease inhibitors and, to a lesser extent, nucleoside reverse transcriptase inhibitors are believed to participate in their pathogenic mechanisms. Because of similarities to the pathogenesis of diabetes mellitus, management of antiretroviral-induced hyperglycemia could follow that the recommendations of the American Diabetes Association, with special considerations for monitoring patients with HIV infection. Future studies of altered glucose metabolism in HIV-infected patients should focus on understanding the precise mechanism or causes of this complication so that preventive and therapeutic guidelines can be further evaluated.
综述人类免疫缺陷病毒（HIV）感染、抗逆转录病毒药物及其他常用药物治疗等因素对HIV感染患者糖代谢的影响。
通过检索1980年至2000年4月的医学文献数据库（MEDLINE）及其他二手资料（近期科学会议上发表的摘要、药品说明书）获取相关文献。检索关键词为抗逆转录病毒治疗、HIV感染、胰岛素抵抗和代谢异常。纳入所有被认为与评估HIV感染及药物治疗对HIV感染患者糖代谢影响相关的信息。
HIV感染患者体内的病毒载量和应激反应引发复杂的激素和免疫反应，可能改变包括糖代谢在内的多种生化途径。在高效抗逆转录病毒治疗时代之前胰岛素抵抗较为罕见，但现在已被描述为脂肪代谢障碍综合征的重要组成部分。糖代谢失调具有复杂性和多因素性，这使得HIV感染患者的高血糖或糖尿病管理具有挑战性。在此背景下，制定了一系列建议，以指导医生评估、治疗和监测HIV感染患者的高血糖或糖尿病。
自高效抗逆转录病毒治疗应用以来，HIV感染患者中观察到的糖代谢改变更为常见。尽管此类异常的病因尚不清楚，但蛋白酶抑制剂以及程度较轻的核苷类逆转录酶抑制剂被认为参与了其发病机制。由于与糖尿病发病机制相似，抗逆转录病毒药物引起的高血糖管理可遵循美国糖尿病协会的建议，并特别考虑对HIV感染患者进行监测。未来关于HIV感染患者糖代谢改变的研究应聚焦于了解这一并发症的确切机制或原因，以便进一步评估预防和治疗指南。
