Impact of Switching Antiretroviral Therapy on Lipodystrophy and Other Metabolic Complications: A Review

Following the introduction of HAART, metabolic and morphological complications known as HIV-associated lipodystrophy syndrome (HALS) have been increasingly common.

The approaches to target these complications span from resistance exercise, diet and use of the antidiabetics metformin or glitazones to recombinant human growth hormone therapy (Serostim) or switching antiretroviral the regimen.

When looking at the effect of switching therapy, focus has been addressed to protease inhibitor (PI) based regimens, as PI was the first component of HAART recognized to be correlated with the disfiguring body-alterations known as HIV-associated lipodystrophy syndrome (HALS).

More recently, however, regimens containing nucleoside reverse-transcriptase inhibitors (NRTI) have attracted attention.

Reviewing switch studies regarding metabolic parameters and body shape changes, certain trends emerge.

Switching from PI, the metabolic complications such as dyslipidemia and insulin resistance seem to be partly reversible, whereas the morphologic alterations appear to be unchanged.

In studies in which NRTIs are switched, dyslipidemia appears unaffected, but a modest improvement in peripheral lipoatrophy has been reported. However, the results are often inconsistent and difficult to interpret, mostly because of limitations in study design, patient number and duration of follow-up.

The need for larger, controlled, randomized, long-term studies is evident.

Department of Infectious Diseases, Hvidovre University Hospital, Denmark. brhansen@dadlnet.dk.

06/23/04