Jain R G, Furfine E S, Pedneault L, White A J, Lenhard J M
Department of Metabolic Diseases, GlaxoSmithKline Inc., 5 Moore Drive, 27709, Research Triangle Park, NC, USA.
Antiviral Res. 2001 Sep;51(3):151-77. doi: 10.1016/s0166-3542(01)00148-6.
Mortality rates in the HIV-infected patient population have decreased with the advent of highly active antiretroviral therapy (HAART) for the treatment of AIDS. Due to the chronic nature of HAART, long-term metabolic complications are associated with therapy, such as hyperlipidemia, fat redistribution and diabetes mellitus. Currently, all of these symptoms are classified as the lipodystrophy (LD) syndrome(s). However, hyperlipidemia and fat redistribution occur independently, indicating there may be multiple syndromes associated with HAART. Although fat gain/loss and dyslipidemia occur in protease inhibitor (PI) naïve patients treated with nucleoside reverse transcriptase inhibitors (NRTIs), combination therapies (PI and NRTI) accelerate the syndrome. Recent clinical trials, cell culture and animal studies indicate that these effects are not drug class specific and select PIs, NRTIs and non-nucleoside reverse transcriptase inhibitors (NNRTIs) can be associated with metabolic complications. Moreover, the effects can vary between various members of the same class of antiretroviral agents (i.e. not all PIs cause the same adverse reactions) and may be influenced by duration of infection, genetics and environmental factors. Although HAART increases the risk of metabolic complications, this does not outweigh the benefits of survival. In this review, we summarize the latest clinical and scientific information on these metabolic complications, examine current hypotheses explaining the syndromes and comment on the existing methods available to manage these metabolic side effects.
随着用于治疗艾滋病的高效抗逆转录病毒疗法（HAART）的出现，HIV感染患者群体的死亡率有所下降。由于HAART具有慢性特点，长期的代谢并发症与该疗法相关，如高脂血症、脂肪重新分布和糖尿病。目前，所有这些症状都被归类为脂肪代谢障碍（LD）综合征。然而，高脂血症和脂肪重新分布是独立发生的，这表明可能存在多种与HAART相关的综合征。尽管在接受核苷类逆转录酶抑制剂（NRTIs）治疗的未使用蛋白酶抑制剂（PI）的患者中会出现脂肪增减和血脂异常，但联合疗法（PI和NRTI）会加速这种综合征的发展。最近的临床试验、细胞培养和动物研究表明，这些影响并非特定药物类别所特有，某些PI、NRTI和非核苷类逆转录酶抑制剂（NNRTIs）都可能与代谢并发症有关。此外，同一类抗逆转录病毒药物的不同成员之间的影响可能有所不同（即并非所有PI都会引起相同的不良反应），并且可能受到感染持续时间、遗传和环境因素的影响。尽管HAART增加了代谢并发症的风险，但这并没有超过生存带来的益处。在本综述中，我们总结了关于这些代谢并发症的最新临床和科学信息，审视了解释这些综合征的当前假说，并对管理这些代谢副作用的现有方法进行了评论。
