Aboud M, Elgalib A, Kulasegaram R, Peters B
Genitourinary Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Int J Clin Pract. 2007 Mar;61(3):463-72. doi: 10.1111/j.1742-1241.2006.01267.x.
Highly active antiretroviral therapy (HAART) has markedly improved the prognosis of people with HIV infection. However, there are long-term side effects associated with HAART. Alterations in metabolic parameters are common and include hyperlipidaemia and insulin resistance (IR), either in isolation or as part of the lipodystrophy and metabolic syndromes. Insulin resistance is common in HIV-infected people, particularly among those being treated with protease inhibitor therapy. The prevalence of hyperglycaemia and diabetes mellitus is significantly higher in people with HIV infection being treated with antiretrovirals (ARVs), as compared with the general population. Hyperglycaemia is an important risk factor for the development of secondary pathology, including cardiovascular disease. It is therefore important to consider the effects of IR in HIV-infected individuals, and take measures to prevent or manage it appropriately. There is limited evidence for the benefit of pharmacological interventions for IR alone although the metabolic changes and body shape changes of lipodystrophy might benefit from the combined use of metformin with exercise. At present, therefore, it is best to concentrate on preventative measures, including lifestyle modification, the careful selection of ARV drugs, and changing drug combinations where appropriate.
高效抗逆转录病毒疗法（HAART）显著改善了HIV感染者的预后。然而，HAART存在长期副作用。代谢参数改变很常见，包括血脂异常和胰岛素抵抗（IR），可单独出现，也可作为脂肪代谢障碍和代谢综合征的一部分。胰岛素抵抗在HIV感染者中很常见，尤其是在接受蛋白酶抑制剂治疗的患者中。与普通人群相比，接受抗逆转录病毒药物（ARV）治疗的HIV感染者中高血糖和糖尿病的患病率显著更高。高血糖是包括心血管疾病在内的继发性病变发展的重要危险因素。因此，考虑IR对HIV感染者的影响并采取措施适当预防或管理它很重要。虽然单独使用药物干预治疗IR的益处证据有限，但二甲双胍与运动联合使用可能会使脂肪代谢障碍的代谢变化和体型变化受益。因此，目前最好专注于预防措施，包括改变生活方式、谨慎选择ARV药物以及在适当情况下更换药物组合。
