The use of highly active antiretroviral combination therapy (HAART) has led to a marked reduction in deaths from acquired immunodeficiency syndrome (AIDS). However, as a result of increasing viral resistance and serious metabolic toxicities associated with their long-term use, rising rates of morbidity and mortality from human immunodeficiency virus (HIV) are predicted. HAART-related lipodystrophy, which has been strongly linked to HIV-1 protease inhibitor use, is characterized by fat redistribution and profound disturbances of the lipid and glucose axes. Nucleoside analogue HIV-1 reverse transcriptase inhibitors appear to be cofactorial in its development, such that switching to protease inhibitor–sparing combinations may not be an option because of incomplete reversal of lipodystrophy and loss of virologic control. Because metabolic changes are the focus of much research at present, there has been a renewal of interest in the pathogenesis of AIDS wasting syndrome and its treatment with androgens and growth hormone.
*Lecturer, University of New South Wales, National Centre in HIV Epidemiology and Clinical Research, Darlinghurst, Sydney, NSW; †Consultant Haematologist, St. Vincent’s Hospital, Darlinghurst, Sydney, NSW, Australia.
Correspondence to Dr. Sarah L. Pett, University of New South Wales, National Centre in HIV Epidemiology and Clinical Research, 376, Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia; e-mail: email@example.com.