Milinković Ana
Clinical Institute of Infections and Immunology, Hospital Clinic, Barcelona, Spain.
Coll Antropol. 2006 Dec;30 Suppl 2:59-62.
In recent years, lipodystrophy and its related complications have become one of the major problems confronting HIV-infected patients on antiretroviral therapy. More than ten years after having been described for the first time, comprehensive knowledge of its underlying molecular basis, the natural history of body fat changes and metabolic abnormalities, and even a working definition of lipodystrophy are all still lacking. No standardized objective assessment of body fat has been incorporated into clinical practice for patient monitoring. Although a huge amount of data has been generated, no clinically proven treatment for any feature of lipodystrophy is currently available. The only intervention that has been shown to reverse lipoatrophy had been the discontinuation of thymidine analogues, although even then the results obtained are at most partial or modest. Recently published studies using uridine (NucleomaxX) and pravastatin resulted in a significant increase of subcutaneous fat. The potential for reversing lipodystrophy once it has developed is limited, but promising results in preventing it are obtained with thymidine analogue-sparing initial antiretroviral regimens. These results raise the question of whether we may be facing a definitive solution to the lipodystrophy syndrome.
近年来，脂肪代谢障碍及其相关并发症已成为接受抗逆转录病毒治疗的HIV感染患者面临的主要问题之一。自首次被描述十多年来，对其潜在分子基础、体脂变化及代谢异常的自然史，甚至脂肪代谢障碍的有效定义仍缺乏全面认识。目前临床实践中尚未纳入用于患者监测的标准化体脂客观评估方法。尽管已产生大量数据，但目前尚无经临床验证的针对脂肪代谢障碍任何特征的治疗方法。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，不过即便如此，所获结果至多只是部分或适度改善。最近发表的使用尿苷（NucleomaxX）和普伐他汀的研究使皮下脂肪显著增加。脂肪代谢障碍一旦发生，逆转的可能性有限，但采用避免使用胸苷类似物的初始抗逆转录病毒治疗方案在预防方面取得了有前景的结果。这些结果引发了一个问题，即我们是否可能正在面对脂肪代谢障碍综合征的最终解决方案。
