The human immunodeficiency virus, HIV infects many cells of the immune system and causes acquired immunodeficiency syndrome, or AIDS. The treatment guidelines developed by the U.S. Department of Health and Human Services, or DHHS, advocate combination ant-retroviral therapy for persons infected with HIV to reduce the complications and mortality of AIDs and decrease HIV transmission from person to person. Recently, HIV-infected patients have been found to exhibit several metabolic disorders that greatly decrease their quality of life. The U.S. panel of the International AIDS Society cites treatment of HIV-related metabolic complications as a necessary component for successful anti-retroviral therapy.
Glucose Metabolism
A 2009 review study in "Toxicologic Pathology" states that HIV-infected patients treated with combination anti-retroviral therapy have an increased risk for type 2 diabetes; protease inhibitors are the primary cause. Other anti-retroviral drugs that are associated with increasing insulin resistance are the nucleoside analogue reverse transcriptase inhibitors.
Although some anti-retroviral drugs do play a role in causing some of the metabolic abnormalities in HIV-infected people, a 2008 study published in "Diabetes and Metabolism" reported that the viral load and chronic progressive destruction of the immune system are instrumental in causing insulin resistance and other disorders of glucose and fat metabolism.
Fat Metabolism
Protease inhibitors and nucleoside analogue reverse transcriptase inhibitors used in the combination anti-retroviral regimen are also implicated in increasing triglyceride levels, exacerbating abnormal lipid profiles, and/or influencing fat distribution. Inflammatory mediators already present in HIV-infected patients, however, may play a larger role in disrupting fat metabolism. Also, not all protease inhibitors cause lipid abnormalities.
Cardiovascular Disease
HIV-infected persons have an increased risk for cardiovascular disease. HIV-infected people who display the classical risk factors of heart disease, such as obesity, high cholesterol, high triglycerides, abnormal lipid profile, insulin resistance and hypertension, are at even greater risk. It is debated whether the cause of the increased cardiovascular disease risk in HIV-infected patients is from anti-retroviral therapy, patient predisposing factors or associated with the disease itself. A 2009 review in the journal "Current Opinion in Infectious Disease" purported all three play a role in the development of cardiovascular disease and recommends that patients with HIV infection who display the classical risk factors for cardiovascular disease should be monitored and treated. Additionally, the authors of this study stated any risks of cardiovascular disease caused by anti-retroviral therapy do not outweigh the benefits gained from treatment. The DHHS states that there is evidence from studies that suggest anti-retroviral therapy actually decreases the risk of cardiovascular disease by reducing the levels of inflammatory mediators that injure large blood vessels.
References
- "Journal of Acquired Immunodeficiency Syndromes"; Management of Metabolic Complications Associated with Anti-retroviral Therapy for HIV-1 Infection
- "Toxicologic Pathology"; The Role of Protease Inhibitors in the Pathogenesis of HIV-Associated Lipodystrophy
- PubMed/"Current Opinion in Infectious Disease": Cardiovascular Disease and HIV Infection: Host, Virus, or Drugs?
- Aids Info: Guidelines for the use of Antiretroviral Agents in HIV-1-infected Adults and Adolescents
- "Diabetes and Metabolism"; Metabolic Disorders and Chronic Viral Disease
