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Insulin Resistance and the cardiometabolic syndrome in HIV infection

Maurizio Bevilacqua1, Ligia J Dominguez, Mario Barbagallo

  • 1Endocrinology and Diabetes Unit, Department of Medicine, Luigi Sacco Hospital (Vialba), University of Milan, Milan, Italy. mauriziobevilacqua@fastwebnet.it

Journal of the Cardiometabolic Syndrome
|February 28, 2009
PubMed

Insights

Highly active antiretroviral therapy (HAART) improves HIV prognosis but can cause metabolic issues like insulin resistance (IR) and lipodystrophy. Lifestyle changes and specific medications may help manage these adverse effects.

Area of Science:

  • Internal Medicine
  • Infectious Diseases
  • Endocrinology

Background:

  • Highly active antiretroviral therapy (HAART) significantly improves outcomes for HIV-positive individuals.
  • Long-term HAART use is associated with adverse metabolic effects, including dyslipidemia, insulin resistance (IR), lipodystrophy, and cardiometabolic syndrome (CMS).

Purpose of the Study:

  • To evaluate the impact of HAART on metabolic complications in HIV patients.
  • To explore strategies for managing insulin resistance and associated conditions in this population.

Main Methods:

  • Review of literature concerning HAART, metabolic side effects, and management strategies.
  • Analysis of the relationship between specific antiretroviral drug classes and metabolic alterations.

Main Results:

  • Insulin resistance (IR) in HIV patients may not be an independent cardiovascular risk factor but contributes to increased risk when combined with dyslipidemia, fat redistribution, and CMS.
  • Nucleoside analogue reverse transcriptase inhibitors are linked to visceral fat accumulation and IR.
  • Lifestyle modifications and judicious HAART regimen selection can mitigate IR progression.

Conclusions:

  • Managing IR and associated metabolic complications is crucial for improving the long-term health of HIV-positive patients on HAART.
  • Metformin and exercise may benefit patients with significant IR and preserved fat distribution, while rosiglitazone is not recommended.

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