Metreleptin treatment of non-HIV lipodystrophy syndromes

As individuals affected by HIV/AIDS live longer due to the availability of HAART, the challenge to health care professionals is to manage and alleviate abnormalities associated with HAART. HIVlipodystrophy- altered body fat redistribution- is the most common stigmatising physical abnormality related to the use of HAART, which maybe alleviated by exercise participation. Currently, there is no reliable management standard care for HIV-associated lipodystrophy. However, there is sufficient evidence to support the benefits of exercise in adults with HIV infection. As various types of ARTs become available in the most HIV/AIDS stricken developing countries, there are inadequate studies to evaluate and promote exercise in alleviating HIV lipodystrophy and other related complications. The current paper reviews HIV-related lipodystrophy, related metabolic dysfunction, and the role of exercise in its management. The paper highlights the need to evaluate the effectiveness of exercise on HIV lipodystrophy syndrome. An emphasis needs to be put on raising awareness among health care professionals in Sub-Saharan Africa where the prevalence of HIV/AIDS is the highest in the world.

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Pathophysiology of Adipocyte Defects and Dyslipidemia in HIV Lipodystrophy: New Evidence from Metabolic and Molecular Studies

American Journal of Infectious Diseases ◽

10.3844/ajidsp.2006.167.172 ◽

2006 ◽

Vol 2 (3) ◽

pp. 167-172 ◽

Cited By ~ 2

Author(s):

Ashok Balasubram ◽

Rajagopal V. Sekhar ◽

Farook Jahoor ◽

Henry J. Pownall ◽

Dorothy Lewis

Keyword(s):

Molecular Studies ◽

Hiv Lipodystrophy ◽

New Evidence

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Increased systemic and adipose tissue cytokines in patients with HIV-associated lipodystrophy

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00056.2003 ◽

2004 ◽

Vol 286 (2) ◽

pp. E261-E271 ◽

Cited By ~ 88

Author(s):

Julia A. Johnson ◽

Jeanine B. Albu ◽

Ellen S. Engelson ◽

Susan K. Fried ◽

Yoritaro Inada ◽

...

Keyword(s):

Adipose Tissue ◽

Highly Active Antiretroviral Therapy ◽

Proinflammatory Cytokine ◽

Whole Body ◽

Metabolic Abnormalities ◽

Lipodystrophy Syndrome ◽

Highly Active ◽

Tnf Α ◽

Adipose Tissue Remodeling ◽

Hiv Lipodystrophy

The lipodystrophy syndrome (adipose tissue redistribution and metabolic abnormalities) observed with highly active antiretroviral therapy (HAART) during human immunodeficiency virus (HIV) infection may be related to increased proinflammatory cytokine activity. We measured acute cytokine (TNF-α, IL-6, leptin), glycerol, and lactate secretion from abdominal subcutaneous adipose tissue (SAT), and systemic cytokine levels, in HIV-infected subjects with and without lipodystrophy (HIVL+ and HIVL–, respectively) and healthy non-HIV controls. Lipodystrophy was confirmed and characterized as adipose tissue redistribution in HIVL+ compared with HIVL– and controls, by dual-energy X-ray absorptiometry and by whole body MRI. TNF-α secretion from abdominal SAT and circulating levels of IL-6, soluble TNF receptors I and II, and insulin were elevated in HIVL+ relative to HIVL– and/or controls, particularly in HIVL+ undergoing HAART. In the HIV-infected group as a whole, IL-6 secretion from abdominal SAT and serum IL-6 were positively associated with visceral fat and were negatively associated with the relative amount of lower limb adipose tissue ( P < 0.01). Decreased leptin and increased lactate secretion from abdominal SAT were specifically associated with HAART. In conclusion, increased cytokine secretion from adipose tissue and increased systemic proinflammatory cytokine activity may play a significant role in the adipose tissue remodeling and/or the metabolic abnormalities associated with the HIV-lipodystrophy syndrome in patients undergoing HAART.

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HIV-Associated Lipodystrophy and Lipoatrophy

10.1093/med/9780190493097.003.0046 ◽

2017 ◽

Author(s):

Rajagopal V. Sekhar

Keyword(s):

Fat Distribution ◽

Natural Evolution ◽

Metabolic Complications ◽

Body Habitus ◽

Specific Effects ◽

Hiv Virus ◽

Antiretroviral Medications ◽

Drug Regimens ◽

Central Fat ◽

Hiv Lipodystrophy

Patients with HIV have been seen to manifest unusual changes in body habitus that constitute variable combinations of peripheral fat loss ( lipoatrophy), central fat accumulation (lipohypertrophy), and the condition known as HIV-associated lipodystrophy (HAL). Although the origins of HAL are unclear, several factors have been linked to it. Because better antiretroviral therapy (ART) drug regimens have led to increased longevity, it is possible that the natural evolution of metabolic complications of HIV is the lipodystrophic phenotype. The specific effects of antiretroviral medications have also been implicated, and the initial usage of ART in the 1990s was accompanied by multiple reports of abnormalities in body fat distribution variously termed the “protease paunch,” “crixivan belly,” among others. Other factors include immune phenomenon and effects mediated directly by the HIV virus. Despite intensive research to understand the mechanistic underpinnings of HIV lipodystrophy and lipoatrophy, the answers remain elusive.

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