HAART-Associated Body Habitus and Metabolic Changes, Part 1
HAART-Associated Body Habitus and Metabolic Changes, Part 1
In the era of HAART, mortality and morbidity rates have declined significantly; yet, nutrition-related problems faced by HIV-positive persons have multiplied. In addition to the AIDS wasting syndrome, previously reviewed in this column, for several years, patients have been faced with alarming body habitus and metabolic changes associated, in some way, with HAART. Common body habitus changes encountered as a part of this syndrome include, among others, visceral fat accumulation in the abdomen, peripheral lipoatrophy, facial wasting, breast enlargement in women, and enlargement of the dorsocervical fat pad ("buffalo hump"). Metabolic changes include hypercholesterolemia and hypertriglyceridemia as well as insulin resistance. Recently, there have also been reports of accelerated bone mineral loss in patients receiving HAART.
As a recent pilot study showed, these problems are very disturbing to patients and may have a significant impact on their psychological well-being. The effect on patients may be underappreciated by physicians. This may lead to nonadherence and other health care problems, especially since the physician is frequently unable to provide any definitive information regarding the cause or treatment of the lipodystrophy syndrome.
Patients and physicians should understand that the origin of the body habitus and metabolic changes associated with lipodystrophy and their association with HAART are not fully known or understood. The focus of nutritional research in HIV has shifted toward evaluation and treatment of these problems. This column will review the current studies and data that have evaluated the potential causes and treatments of this syndrome.
In the era of HAART, mortality and morbidity rates have declined significantly; yet, nutrition-related problems faced by HIV-positive persons have multiplied. In addition to the AIDS wasting syndrome, previously reviewed in this column, for several years, patients have been faced with alarming body habitus and metabolic changes associated, in some way, with HAART. Common body habitus changes encountered as a part of this syndrome include, among others, visceral fat accumulation in the abdomen, peripheral lipoatrophy, facial wasting, breast enlargement in women, and enlargement of the dorsocervical fat pad ("buffalo hump"). Metabolic changes include hypercholesterolemia and hypertriglyceridemia as well as insulin resistance. Recently, there have also been reports of accelerated bone mineral loss in patients receiving HAART.
As a recent pilot study showed, these problems are very disturbing to patients and may have a significant impact on their psychological well-being. The effect on patients may be underappreciated by physicians. This may lead to nonadherence and other health care problems, especially since the physician is frequently unable to provide any definitive information regarding the cause or treatment of the lipodystrophy syndrome.
Patients and physicians should understand that the origin of the body habitus and metabolic changes associated with lipodystrophy and their association with HAART are not fully known or understood. The focus of nutritional research in HIV has shifted toward evaluation and treatment of these problems. This column will review the current studies and data that have evaluated the potential causes and treatments of this syndrome.
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