Wohl David A
University of North Carolina, Chapell Hill, NC, USA.
Top HIV Med. 2004 Jul-Aug;12(3):89-93.
Body-shape changes and lipid abnormalities are common metabolic disorders in HIV-infected persons. It is likely that numerous factors contribute to body-morphology changes, including antiretroviral therapy, HIV infection itself, and immune reconstitution under antiretroviral therapy. A recent large cross-sectional investigation, the Fat Redistribution and Metabolism (FRAM) study, suggests that lipoatrophy is the most common feature of body-shape changes. Recent findings suggest modest benefit in reversing fat wasting by switching to abacavir from stavudine or zidovudine but no benefit from rosiglitazone treatment or switching from protease inhibitor to nonnucleoside reverse transcriptase inhibitor therapy. Human growth hormone treatment reduces fat accumulation, but treatment is expensive and gains in this regard are lost when treatment is stopped. Guidelines for treating lipid abnormalities in the non-HIV-infected population generally apply to HIV-infected persons; however, drug-drug interactions and overlapping toxicities between HIV and lipid therapies must be recognized. Although antiretroviral agents can raise lipid levels, there are data to suggest that in the case of cholesterol, HIV therapy reverses HIV infection-induced reductions of all cholesterol subsets. There are conflicting data regarding whether there is increased cardiovascular morbidity and mortality in the HIV-infected population. On balance, it appears that cardiovascular disease due to HIV-associated lipid disorders currently is a relatively infrequent problem, but once that is increasing in magnitude. This article summarizes a presentation by David A. Wohl, MD, at the February 2004 International AIDS Society-USA course in Atlanta.
体型改变和脂质异常是HIV感染者常见的代谢紊乱。可能有多种因素导致体型变化，包括抗逆转录病毒疗法、HIV感染本身以及抗逆转录病毒疗法下的免疫重建。最近一项大型横断面研究——脂肪重新分布与代谢（FRAM）研究表明，脂肪萎缩是体型变化最常见的特征。最近的研究结果显示，从司他夫定或齐多夫定改用阿巴卡韦在逆转脂肪消耗方面有一定益处，但罗格列酮治疗或从蛋白酶抑制剂转换为非核苷类逆转录酶抑制剂治疗并无益处。生长激素治疗可减少脂肪堆积，但治疗费用昂贵，且停药后这方面的效果会消失。非HIV感染人群脂质异常的治疗指南通常也适用于HIV感染者；然而，必须认识到HIV与脂质疗法之间的药物相互作用和重叠毒性。尽管抗逆转录病毒药物会升高脂质水平，但有数据表明，就胆固醇而言，HIV治疗可逆转HIV感染引起的所有胆固醇亚类的降低。关于HIV感染人群心血管发病率和死亡率是否增加，存在相互矛盾的数据。总体而言，似乎由HIV相关脂质紊乱导致的心血管疾病目前是一个相对少见的问题，但有迹象表明其发生率正在上升。本文总结了医学博士大卫·A·沃尔在2004年2月于亚特兰大举行的美国国际艾滋病学会课程上的一次演讲。
