Milinkovic Ana, Martinez Esteban
Clinical Institute of Infections and Immunology, Institu d'Investigacions Biomédiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain.
J Antimicrob Chemother. 2005 Jul;56(1):6-9. doi: 10.1093/jac/dki165. Epub 2005 May 19.
In recent years, lipodystrophy and its related complications have changed from an anecdotal issue into a major problem for HIV-infected patients on antiretroviral therapy. Despite great efforts to achieve a consensus in defining this problem, a simple, readily available definition is still lacking. More comprehensive knowledge of the underlying molecular basis and the natural history of body fat changes and metabolic abnormalities is needed to make progress. Also, an objective assessment of body fat is still to be incorporated in clinical practice, so interventions to prevent or treat body fat changes cannot be adequately monitored. Several objective techniques have been used, and all of them have limitations and advantages. There seems to be a good correlation between different techniques for measuring fat, but that is not the case for detecting fat changes. A huge amount of data have been generated on how to manage lipodystrophy. Nevertheless, there is no clinically proven treatment for any feature of lipodystrophy. The only intervention that has been shown to reverse lipoatrophy is the discontinuation of thymidine analogues, but the results obtained are partial or modest at most. Structured therapy interruptions have become an increasingly popular strategy aimed at preventing or reducing antiretroviral drug toxicity, but little objective data exist on their impact on body composition of HIV-infected patients. The issue of body composition has become extremely important for the adequate management of HIV-infected patients.
近年来，脂肪代谢障碍及其相关并发症已从一个轶事性问题转变为接受抗逆转录病毒治疗的HIV感染患者面临的一个主要问题。尽管在界定这一问题上已做出巨大努力以达成共识，但仍缺乏一个简单、易于获取的定义。需要对潜在的分子基础以及体脂变化和代谢异常的自然史有更全面的了解，才能取得进展。此外，体脂的客观评估仍有待纳入临床实践，因此预防或治疗体脂变化的干预措施无法得到充分监测。已使用了几种客观技术，它们都有局限性和优点。不同的脂肪测量技术之间似乎有良好的相关性，但在检测脂肪变化方面并非如此。关于如何管理脂肪代谢障碍已产生了大量数据。然而，对于脂肪代谢障碍的任何特征都没有经临床验证的治疗方法。唯一被证明可逆转脂肪萎缩的干预措施是停用胸苷类似物，但所获得的结果最多只是部分的或适度的。结构化治疗中断已成为一种越来越流行的策略，旨在预防或降低抗逆转录病毒药物毒性，但关于其对HIV感染患者身体成分影响的客观数据很少。身体成分问题对于HIV感染患者的充分管理已变得极为重要。
