Department of Clinical and Experimental Medicine, Section of Infectious Diseases, "Alma Mater Studiorum" University of Bologna, S. Orsola Hospital, Bologna, Italy.
Metab Syndr Relat Disord. 2004 Fall;2(4):241-50. doi: 10.1089/met.2004.2.241.
The introduction of highly active antiretroviral therapy (HAART) has dramatically improved the long-term prognosis of human immunodeficiency virus (HIV)-infected patients, but several abnormalities of lipid and glucose metabolism have recently been reported with increasing frequency in patients receiving potent new antiretroviral combinations. Although a rare occurrence before the HAART era, insulin resistance has now been described as an important component of the lipodystrophy syndrome, including body fat redistribution, hypertriglyceridemia, hypercholesterolemia, hyperinsulinemia, and hyperglycemia. The etiology of such abnormalities remains unclear; but protease inhibitors and, to a lesser extent, nucleoside reverse transcriptase inhibitors are believed to contribute to the pathogenetic mechanism. The potential clinico-pathological consequences of glucose metabolism dysregulation, such as atherosclerosis and coronary heart disease, all make the management of insulin resistance and diabetes mellitus a challenge in the management of HIV-infected patients. Because of similarities to pathogenesis and clinical presentation of type 2 diabetes mellitus, treatment of HAART-associated hyperinsulinemia and hyperglycemia could follow the recommendations of the American Diabetes Association, but the most effective and safe management of these metabolic alterations is still unknown. The present review evaluated the most recently published data about incidence, risk factors, pathogenesis, clinical complications, and management of glucose disorders associated with antiretroviral therapy.
高效抗逆转录病毒疗法（HAART）的引入极大地改善了人类免疫缺陷病毒（HIV）感染患者的长期预后，但最近越来越频繁地报道了接受强效新抗逆转录病毒联合治疗的患者中出现几种脂质和糖代谢异常。尽管在 HAART 时代之前很少发生，但胰岛素抵抗现在已被描述为脂肪营养不良综合征的一个重要组成部分，包括体脂重新分布、高三酰甘油血症、高胆固醇血症、高胰岛素血症和高血糖症。这种异常的病因仍不清楚；但蛋白酶抑制剂，在较小程度上，核苷逆转录酶抑制剂被认为有助于发病机制。糖代谢失调的潜在临床病理后果，如动脉粥样硬化和冠心病，都使 HIV 感染患者的胰岛素抵抗和糖尿病的管理成为一个挑战。由于与 2 型糖尿病的发病机制和临床表现相似，治疗与 HAART 相关的高胰岛素血症和高血糖症可以遵循美国糖尿病协会的建议，但这些代谢改变的最有效和安全的管理方法仍不清楚。本综述评估了最近发表的关于与抗逆转录病毒治疗相关的葡萄糖紊乱的发生率、危险因素、发病机制、临床并发症和管理的最相关数据。
