Division of Infectious Diseases and Division of Diabetes, Department of Medicine, Helsinki University Central Hospital, 00029 HUS, Helsinki, Finland.
PPAR Res. 2009;2009:373524. doi: 10.1155/2009/373524. Epub 2008 Dec 1.
Highly active antiretroviral therapy (HAART)-associated metabolic complications include lipoatrophy (loss of subcutaneous adipose tissue (SAT)) and insulin resistance. Thiazolidinediones are insulin-sensitizing antidiabetic agents which-as an untoward side effect in obese diabetic patients-increase SAT. Furthermore, troglitazone has improved lipoatrophy and glycemic control in non-HIV patients with various forms of lipodystrophy. These data have led to 14 clinical trials to examine whether thiazolidinediones could be useful in the treatment of HAART-associated metabolic complications. The results of these studies indicate very modest, if any, effect on lipoatrophic SAT, probably due to ongoing HAART negating the beneficial effect. The benefit might be more prominent in patients not taking thymidine analoges. Despite the poor effect on lipoatrophy, thiazolidin-ediones improved insulin sensitivity. However, especially rosiglitazone induced harmful effects on blood lipids. Current data do not provide evidence for the use of thiazolidinediones in the treatment of HAART-associated lipoatrophy, but treatment of lipoatrophy-associated diabetes may be warranted. The role of thiazolidinediones for novel indications, such as hepatosteatosis, should be studied in these patients.
高效抗逆转录病毒治疗（HAART）相关的代谢并发症包括脂肪萎缩（皮下脂肪组织（SAT）损失）和胰岛素抵抗。噻唑烷二酮类是胰岛素增敏型抗糖尿病药物，在肥胖的糖尿病患者中作为一种不良反应，会增加 SAT。此外，曲格列酮已改善非 HIV 患者各种形式脂肪营养不良的脂肪萎缩和血糖控制。这些数据导致了 14 项临床试验，以检查噻唑烷二酮类药物是否可用于治疗 HAART 相关的代谢并发症。这些研究的结果表明，对脂肪萎缩性 SAT 的影响非常有限，如果有的话，这可能是由于持续的 HAART 抵消了有益的效果。对于未服用胸苷类似物的患者，益处可能更为明显。尽管对脂肪萎缩的效果不佳，但噻唑烷二酮类药物改善了胰岛素敏感性。然而，特别是罗格列酮会对血脂产生有害影响。目前的数据并没有提供使用噻唑烷二酮类药物治疗 HAART 相关脂肪萎缩的证据，但可能需要治疗脂肪萎缩相关的糖尿病。噻唑烷二酮类药物用于新适应症（如肝脂肪变性）的作用，应在这些患者中进行研究。
