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HIV infection, body composition changes and related metabolic complications: contributing factors and evolving management strategies

Falutz, Julian

Current Opinion in Clinical Nutrition and Metabolic Care: May 2011 - Volume 14 - Issue 3 - p 255–260
doi: 10.1097/MCO.0b013e3283457a8f
Translational research in wasting diseases: Edited by Vickie E. Baracos, Didier Attaix and Claude Pichard
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Purpose of review Metabolic toxicities in HIV patients are common and contribute to clinical status and long-term sequelae. Body fat mass alterations, of multifactorial causes, continue to occur, despite use of antiretroviral drugs associated with fewer metabolic side-effects. The role of HIV itself in the development of these changes is being better defined and a deeper understanding of perturbations in intermediary metabolic processes is emerging. Treatment options are also being identified.

Recent findings HIV itself may be a direct causal factor in the accelerated atherosclerosis and decreased levels of high-density lipoprotein that occur and contribute to increased cardiovascular complications. Antiretroviral drug-related and inflammation-related effects can cause mitochondrial toxicity and are an emerging area of research. The association of increased visceral adipose tissue with both drug-related and chronic inflammation-related factors is now better understood. The role of accelerated aging as a paradigm is useful to understand long-term outcome risks for patients. The use of growth hormone-releasing factor as a viable treatment option for increased visceral abdominal tissue has recently been confirmed for selected patients.

Summary Metabolic issues persist in HIV patients who are otherwise stable. Understanding the various inter-related contributing factors has allowed for rapid improvement in patients' clinical status, but long-term consequences are of concern and require ongoing investigation in order to prevent limiting the otherwise important clinical achievements that have recently occurred.

McGill University Health Center, Immunodeficiency Treatment Center, Montreal, Quebec, Canada

Correspondence to Julian Falutz, MDCM, FRCPC, McGill University Health Center, Montreal General Hospital, Room A5-140, 1650 Cedar Avenue, Montreal, QC H3G 1A4, Canada Tel: +1 514 934 8095; fax: +1 514 937 1424; e-mail: julian.falutz@muhc.mcgill.ca

© 2011 Lippincott Williams & Wilkins, Inc.