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The paradox of improved antiretroviral therapy in HIV: potential for nutritional modulation?

Published online by Cambridge University Press:  28 February 2007

Lisa J. Ware  and
S. A. Wootton
Lisa J. Ware*
Affiliation:
Institute of Human Nutrition, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
S. A. Wootton
Affiliation:
Institute of Human Nutrition, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
*
*Corresponding Author: Lisa Ware, present address SHS International Ltd, 100 Wavertree Boulevard, Liverpool L7 9PT, UK, fax +44 (0)151 228 2650, email lware@shsint.co.uk
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Abstract

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Chronic infection with HIV type 1 is associated with alterations in macronutrient metabolism, specifically elevated plasma lipids, glucose and reduced insulin sensitivity. These alterations are most severe in patients at the later stages of AIDS, indicating a relationship with disease progression. Recently, a metabolic syndrome, termed lipodystrophy, has been described in successfully-treated HIV patients in whom the altered macronutrient metabolism of HIV infection appears to be amplified markedly, with concurrent alterations in adipose tissue patterning. This syndrome presents a paradox, as before the development of highly-active antiretroviral therapy (HAART) the most severe perturbations in metabolism were observed in the sickest patients. Now, the patients that respond well to therapy are showing metabolic perturbations much greater than those seen before. The implications of this syndrome are that, whilst life expectancy may be increased by reducing viral load, there are concomitant increases in the risk of cardiovascular disease, diabetes and pancreatitis within this patient population. The aetiology of the syndrome remains unclear. In a collaborative trial with the Chelsea and Westminster Hospital in London we have used stable-isotope-labelled fatty acids to examine the hypothesis that treatment with HAART causes a delayed clearance of dietary lipid from the circulation, resulting in the retention of lipid within plasma and the downstream changes in insulin and glucose homeostasis. This hypothesis would indicate a role for low-fat diets, exercise and drugs that reduce plasma lipid or insulin resistance, in modulating the response to antiretroviral therapy in HIV infection.

Keywords

LipodystrophyHIVMetabolismLipidsStable isotopes
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 61 , Issue 1 , February 2002 , pp. 131 - 136
Copyright
Copyright © The Nutrition Society 2002

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