Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc |
Journal website http://www.jofem.org |
Review
Volume 7, Number 4, August 2017, pages 103-116
Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome and Lipodystrophy: Pathophysiology and Current Therapeutic Interventions
Table
Presentation | Features | Common causes | Suggested interventions |
---|---|---|---|
FBG: fasting blood glucose; IR: insulin resistance; FPI: fasting plasma insulin. | |||
Lipodystrophy | |||
Lipoatrophy | Loss of subcutaneous fat from buccal, periorbital, temporal regions and extremities | NRTIs: Stavudine > zidovudine > didanosine > lamivudine in decreasing order of magnitude | 1. Switch from stavudine or zidovudine to tenofovir or abacavir. Consider new generation NRTIs devoid of adverse-effects. 2. Nutritional therapy: increased dietary flavonoids intake 3. Moderate exercise but may worsen subcutaneous fat loss |
Lipohypertrophy | Gynecomastia, dorsocervical fat pads (buffalo hump). Increased TC, TG and LDL-C with reduced HDL-C | PIs: Saquinavir, nelfinavir, indinavir, ritonavir, atazanavir | 1. Switch to NNRTI or ritonavir boosted atazanavir or darunavir 2. Nutritional therapy 3. Moderate exercise |
Glucose intolerance | |||
Impaired FBG | FBG > 6.0 mM | PIs: Indinavir, saquinavir, nelfinavir, lopinavir NRTIs: stavudine, zidovudine, lamivudine | 1. Switch to ritonavir boosted atazanavir or darunavir 2. Avoid stavudine, zidovudine, lamivudine 3. Nutritional therapy 4. Moderate exercise |
IR | Elevated FPI | PIs: Indinavir, saquinavir, nelfinavir | 1. Switch to ritonavir boosted atazanavir or darunavir 2. Nutritional therapy 3. Moderate exercise |
T2D | Overt hyperglycemia without metabolic complications | PIs: Indinavir, saquinavir, nelfinavir | 1. Nutritional therapy 2. Moderate exercise 3. GLP-1 analogues (avoid metformin) in obese patients 4. Oral hypoglycemics |