scholarly journals The Effects of Thiazolidinediones on Metabolic Complications and Lipodystrophy in HIV-Infected Patients

PPAR Research ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-15 ◽  
Author(s):  
Jussi Sutinen
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Blood Lipids ◽  
Current Data ◽  
Diabetic Patients ◽  
Metabolic Complications ◽  
Highly Active ◽  
The Poor ◽  
Subcutaneous Adipose ◽  
Harmful Effects

Highly active antiretroviral therapy (HAART)-associated metabolic complications include lipoatrophy (loss of subcutaneous adipose tissue (SAT)) and insulin resistance. Thiazolidinediones are insulin-sensitizing antidiabetic agents which—as an untoward side effect in obese diabetic patients—increase SAT. Furthermore, troglitazone has improved lipoatrophy and glycemic control in non-HIV patients with various forms of lipodystrophy. These data have led to 14 clinical trials to examine whether thiazolidinediones could be useful in the treatment of HAART-associated metabolic complications. The results of these studies indicate very modest, if any, effect on lipoatrophic SAT, probably due to ongoing HAART negating the beneficial effect. The benefit might be more prominent in patients not taking thymidine analoges. Despite the poor effect on lipoatrophy, thiazolidin-ediones improved insulin sensitivity. However, especially rosiglitazone induced harmful effects on blood lipids. Current data do not provide evidence for the use of thiazolidinediones in the treatment of HAART-associated lipoatrophy, but treatment of lipoatrophy-associated diabetes may be warranted. The role of thiazolidinediones for novel indications, such as hepatosteatosis, should be studied in these patients.

Effects of rosiglitazone on gene expression in subcutaneous adipose tissue in highly active antiretroviral therapy-associated lipodystrophy

2004 ◽  
Vol 286 (6) ◽  
pp. E941-E949 ◽  
Author(s):  
Jussi Sutinen ◽  
Katja Kannisto ◽  
Elena Korsheninnikova ◽  
Rachel M. Fisher ◽  
Ewa Ehrenborg ◽  
...  
Keyword(s):  
Gene Expression ◽  
Insulin Resistance ◽  
Adipose Tissue ◽  
Highly Active Antiretroviral Therapy ◽  
Subcutaneous Adipose Tissue ◽  
Binding Protein ◽  
Lipid Binding ◽  
Liver Fat ◽  
Highly Active ◽  
Subcutaneous Adipose

Highly active antiretroviral therapy (HAART) has improved the prognosis of human immunodeficiency virus (HIV)-infected patients but is associated with severe adverse events, such as lipodystrophy and insulin resistance. Rosiglitazone did not increase subcutaneous fat in patients with HAART-associated lipodystrophy (HAL) in a randomized, double-blind, placebo-controlled trial, although it attenuated insulin resistance and decreased liver fat content. The aim of this study was to examine effects of rosiglitazone on gene expression in subcutaneous adipose tissue in 30 patients with HAL. The mRNA concentrations in subcutaneous adipose tissue were measured using real-time PCR. Twenty-four-week treatment with rosiglitazone (8 mg/day) compared with placebo significantly increased the expression of adiponectin, peroxisome proliferator-activated receptor-γ (PPARγ), and PPARγ coactivator 1 and decreased IL-6 expression. Expression of other genes involved in lipogenesis, fatty acid metabolism, or glucose transport, such as acyl-CoA synthase, adipocyte lipid-binding protein, CD45, fatty acid transport protein-1 and -4, GLUT1, GLUT4, keratinocyte lipid-binding protein, lipoprotein lipase, PPARδ, and sterol regulatory element-binding protein-1c, remained unchanged. Rosiglitazone also significantly increased serum adiponectin concentration. The change in serum adiponectin concentration was inversely correlated with the change in fasting serum insulin concentration and liver fat content. In conclusion, rosiglitazone induced significant changes in gene expression in subcutaneous adipose tissue and ameliorated insulin resistance in patients with HAL. Increased expression of adiponectin might have mediated most of the favorable insulin-sensitizing effects of rosiglitazone in these patients.

Comparison of first antiretroviral treatment duration and outcome in HIV, HIV–HBV and HIV–HCV infection

2007 ◽  
Vol 18 (8) ◽  
pp. 546-550 ◽  
Author(s):  
Curtis L Cooper ◽  
Ed Mills
Keyword(s):  
Substance Abuse ◽  
Highly Active Antiretroviral Therapy ◽  
Treatment Duration ◽  
Treatment Interruption ◽  
Transcriptase Inhibitor ◽  
Hiv Treatment ◽  
Metabolic Complications ◽  
Ottawa Hospital ◽  
Highly Active ◽  
Drug History

Hepatitis C virus (HCV) and hepatitis B virus (HBV) co-infection may differentially influence HIV treatment duration and outcome. This was assessed at The Ottawa Hospital Immunodeficiency Clinic in first-time highly active antiretroviral therapy (HAART) recipients visited between January 2000 and December 2004. Of 968 patients, 526/700 (75%) HIV, 173/230 (75%) HIV–HCV and 30/38 (79%) HIV–HBV-infected patients initiated HAART. Co-infected patients stopped treatment sooner (HBV – 10 months, HCV – 9 months) than HIV mono-infected (17 months) ( P<0.001). Injection drug history predicted shorter treatment duration (odds ratio [OR]1.59, P<0.001). Use of non-nucleoside-reverse-transcriptase-inhibitor-containing HAART (OR 0.76, P<0.01) and low-dose ritonavir (<400 mg twice daily)-based HAART (OR 0.83, P = 0.06) predicted longer treatment duration. HCV co-infection did not predict duration of therapy (OR 1.19, P=0.19) once controlled for by these three variables. Poor adherence was a major explanation for eventual treatment interruption in those with HIV–HCV (22% versus 5% in HIV alone; P<0.001) as was substance abuse (7% versus < 1% in HIV; P<0.001). Metabolic complications resulted in HAART interruption in HIV mono-infection (8%) but not with HBV or HCV co-infection (both <1%; P<0.001). Antiretroviral selection is critical to the longevity of initially prescribed regimens, irrespective of viral hepatitis co-infection. Attention to this and strategies targeting substance abuse and adherence in HIV–HCV are predicted to increase the duration of HAART.

scholarly journals Effect of HSV-2 Suppressive Therapy on Genital Tract HIV-1 RNA Shedding among Women on HAART: A Pilot Randomized Controlled Trial

2012 ◽  
Vol 2012 ◽  
pp. 1-7
Author(s):  
A. E. Nijhawan ◽  
A. K. DeLong ◽  
S. Chapman ◽  
A. Rana ◽  
J. Kurpewski ◽  
...  
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Genital Tract ◽  
Controlled Trial ◽  
Sexual Transmission ◽  
Suppressive Therapy ◽  
Control Group ◽  
Highly Active ◽  
One Year ◽  
Hiv 1

Background. The role of suppressive HSV therapy in women coinfected with HSV-2 and HIV-1 taking highly active antiretroviral therapy (HAART) is unclear.Methods. 60 women with HIV-1/HSV-2 coinfection on HAART with plasma HIV-1 viral load (PVL) ≤75 copies/mL were randomized to receive acyclovir (N=30) or no acyclovir (N=30). PVL, genital tract (GT) HIV-1, and GT HSV were measured every 4 weeks for one year.Results. Detection of GT HIV-1 was not significantly different in the two arms (OR 1.23,P=0.67), although this pilot study was underpowered to detect this difference. When PVL was undetectable, the odds of detecting GT HIV were 0.4 times smaller in the acyclovir arm than in the control arm, though this was not statistically significant (P=0.07). The odds of detecting GT HSV DNA in women receiving acyclovir were significantly lower than in women in the control group, OR 0.38,P<0.05.Conclusions. Chronic suppressive therapy with acyclovir in HIV-1/HSV-2-positive women on HAART significantly reduces asymptomatic GT HSV shedding, though not GT HIV shedding or PVL. PVL was strongly associated with GT HIV shedding, reinforcing the importance of HAART in decreasing HIV sexual transmission.

Lipodystrophy and metabolic complications of highly active antiretroviral therapy

2009 ◽  
Vol 76 (10) ◽  
pp. 1017-1021 ◽  
Author(s):  
Ankit Parakh ◽  
Anand Prakash Dubey ◽  
Ajay Kumar ◽  
Anshu Maheshwari
Keyword(s):  
Antiretroviral Therapy ◽  
Highly Active Antiretroviral Therapy ◽  
Metabolic Complications ◽  
Highly Active
Sign in / Sign up

Export Citation Format

Share Document