HIV-related lipodystrophy has emerged as one of the most prevalent and worrisome problems for patients now that HIV infection can be seen as a chronic disease. Despite its growing importance, crucial issues such as etiopathogenesis, diagnosis, prevention, or therapy remain largely unknown. Current evidence suggests that etiology is multifactorial. HIV infection, antiretroviral therapy, and patient-related factors probably contribute to the development of lipodystrophy. The lack of a formal definition and the different nature of wasting syndrome that may also affect to HIV-infected patients hinder the diagnosis of lipodystrophy. Body fat changes have a major
negative impact on the quality of life. Metabolic abnormalities are well known cardiovascular risk factors that may contribute to increase the morbidity and mortality of cardiovascular origin in a relatively young population. We do not know if lipodystrophy is either preventable or completely revertible. Several therapeutic approaches have been tried with limited success and potential complications. Investigational therapies have mainly consisted of general health measures (diet and exercise), switching antiretrovirals (from protease inhibitors to non-nucleoside reverse transcriptase inhibitors or abacavir, or from stavudine to other nucleoside reverse transcriptase inhibitors), and use of drugs with metabolic effects (metformin, thiazolidinediones, recombinant growth hormone, and anabolic steroids). A judicious use of available data from an individualised approach seems the best option to manage this problem at present.
|
