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Lipodystrophy in HIV: Evolving Challenges and Unresolved Questions.

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Effective HIV treatment has evolved, reducing severe lipodystrophy. However, modern therapies can still cause weight gain and adipose tissue changes, increasing health risks for people living with HIV (PLWH).

Keywords:
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Area of Science:

  • Medical Science
  • Virology
  • Endocrinology

Background:

  • Effective antiretroviral therapy (ART) for HIV emerged in the mid-1990s, preventing AIDS progression.
  • ART was linked to HIV-associated lipodystrophy, characterized by fat redistribution and metabolic issues like insulin resistance.
  • While newer ART regimens have reduced severe lipodystrophy, adipose tissue alterations persist.

Purpose of the Study:

  • To review the evolving landscape of adipose tissue alterations in people living with HIV (PLWH) on modern antiretroviral therapy.
  • To highlight the persistent risks of metabolic and cardiovascular complications associated with these changes.

Main Methods:

  • Literature review of studies on HIV-associated lipodystrophy and antiretroviral therapy.
  • Analysis of the impact of different ART generations on fat metabolism and distribution.
  • Examination of current evidence on weight gain and specific fat depot hypertrophy in PLWH.

Main Results:

  • Early ART (e.g., stavudine) caused significant lipoatrophy and lipomatosis, with associated metabolic disturbances.
  • Modern ART, including integrase strand transfer inhibitors and tenofovir alafenamide, has decreased severe lipodystrophy.
  • Current regimens are linked to weight gain resembling obesity and hypertrophy of visceral fat depots (epicardial, perivascular), increasing cardiovascular risk.

Conclusions:

  • Despite advances in ART, PLWH remain vulnerable to adipose tissue alterations.
  • These changes, including weight gain and visceral fat hypertrophy, pose ongoing metabolic and cardiovascular health risks.
  • Optimized ART and vigilant monitoring of adipose tissue and metabolic status are crucial for improving PLWH health.