Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc
Journal website http://www.jofem.org

Review

Volume 7, Number 4, August 2017, pages 103-116

Highly Active Antiretroviral Therapy-Associated Metabolic Syndrome and Lipodystrophy: Pathophysiology and Current Therapeutic Interventions

Table

Table 1. Conservative Therapeutic Strategies for the Management of HAART-Induced Lipodystrophy
 
PresentationFeaturesCommon causesSuggested interventions
FBG: fasting blood glucose; IR: insulin resistance; FPI: fasting plasma insulin.
Lipodystrophy
  LipoatrophyLoss of subcutaneous fat from buccal, periorbital, temporal regions and extremitiesNRTIs: Stavudine > zidovudine > didanosine > lamivudine in decreasing order of magnitude1. Switch from stavudine or zidovudine to tenofovir or abacavir. Consider new generation NRTIs devoid of adverse-effects.
2. Nutritional therapy: increased dietary flavonoids intake
3. Moderate exercise but may worsen subcutaneous fat loss
  LipohypertrophyGynecomastia, dorsocervical fat pads (buffalo hump). Increased TC, TG and LDL-C with reduced HDL-CPIs: Saquinavir, nelfinavir, indinavir, ritonavir, atazanavir1. Switch to NNRTI or ritonavir boosted atazanavir or darunavir
2. Nutritional therapy
3. Moderate exercise
Glucose intolerance
  Impaired FBGFBG > 6.0 mMPIs: Indinavir, saquinavir, nelfinavir, lopinavir
NRTIs: stavudine, zidovudine, lamivudine		1. Switch to ritonavir boosted atazanavir or darunavir
2. Avoid stavudine, zidovudine, lamivudine
3. Nutritional therapy
4. Moderate exercise
  IRElevated FPIPIs: Indinavir, saquinavir, nelfinavir1. Switch to ritonavir boosted atazanavir or darunavir
2. Nutritional therapy
3. Moderate exercise
  T2DOvert hyperglycemia without metabolic complicationsPIs: Indinavir, saquinavir, nelfinavir1. Nutritional therapy
2. Moderate exercise
3. GLP-1 analogues (avoid metformin) in obese patients
4. Oral hypoglycemics