Strategies in the treatment of HIV-1-associated adipose redistribution syndromes.
Expert Opin Pharmacother
; 8(12): 1871-84, 2007 Aug.
Article
em En
| MEDLINE
| ID: mdl-17696790
ABSTRACT
HIV-1/highly active antiretroviral therapy-associated lipodystrophy syndrome (HALS) is presently the most common long-term adverse effect limiting the doubtless efficacy of antiretroviral therapy. It has a great impact on the quality of life of patients, it is stigmatising and its psychologically devastating consequences may ultimately impact on the adherence to treatment of patients, eventually leading to treatment failure. Despite considerable advances in recent times, the pathogenesis of HALS remains elusive. Factors involved belong to three categories those intrinsic to the host, some of them modifiable and some not, those associated with antiretroviral therapy, that are sometimes modifiable as well, and finally those related to HIV-1 infection and its consequences, most often not modifiable. The most commonly used strategies for HALS reversion have included host-dependent factors such as lifestyle and dietary modifications and antiretroviral-dependent factors such as switching or avoiding the use of drugs more prone to promote HALS. Lifestyle modifications and switching thymidine analogues have been associated with moderate success. Pharmacological interventions have included the use of insulin-sensitising agents and hormone therapy with disappointing results, whereas treatment with pravastatin or pioglitazone, and uridine supplementation seem to be associated with fat gain in preliminary studies. The only interventions with almost immediate results that may render a patient's appearance similar to his past one have included filling techniques for facial lipoatrophy and ultrasound-assisted liposuction for cervical fat pad hypertrophy. Among the filling options, semipermanent reabsorbable materials and autologous fat transfer have been associated with acceptable outcomes. As of now, the best hope should rely on the use of drugs friendly for fat, on defining the appropriate timing for starting antiretroviral and on continuing the research effort to understand the basic mechanisms underlying HALS pathogenesis. Only through this effort can the best chances for preventing or reverting established HALS be recognised.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fármacos Anti-HIV
/
Terapia Antirretroviral de Alta Atividade
/
Síndrome de Lipodistrofia Associada ao HIV
Tipo de estudo:
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Expert Opin Pharmacother
Assunto da revista:
FARMACOLOGIA
Ano de publicação:
2007
Tipo de documento:
Article
País de afiliação:
Espanha