HIV and antiretroviral therapy-related fat alterations

John R. Koethe, Claire Lagathu, Jordan E. Lake, Pere Domingo, Alexandre Calmy, Julian Falutz, Todd T. Brown, Jacqueline Capeau

Research output: Contribution to journalArticle

Abstract

Early in the HIV epidemic, lipodystrophy, characterized by subcutaneous fat loss (lipoatrophy), with or without central fat accumulation (lipohypertrophy), was recognized as a frequent condition among people living with HIV (PLWH) receiving combination antiretroviral therapy. The subsequent identification of thymidine analogue nucleoside reverse transcriptase inhibitors as the cause of lipoatrophy led to the development of newer antiretroviral agents; however, studies have demonstrated continued abnormalities in fat and/or lipid storage in PLWH treated with newer drugs (including integrase inhibitor-based regimens), with fat gain due to restoration to health in antiretroviral therapy-naive PLWH, which is compounded by the rising rates of obesity. The mechanisms of fat alterations in PLWH are complex, multifactorial and not fully understood, although they are known to result in part from the direct effects of HIV proteins and antiretroviral agents on adipocyte health, genetic factors, increased microbial translocation, changes in the adaptive immune milieu after infection, increased tissue inflammation and accelerated fibrosis. Management includes classical lifestyle alterations with a role for pharmacological therapies and surgery in some patients. Continued fat alterations in PLWH will have an important effect on lifespan, healthspan and quality of life as patients age worldwide, highlighting the need to investigate the critical uncertainties regarding pathophysiology, risk factors and management.

Original languageEnglish (US)
Article number48
JournalNature Reviews Disease Primers
Volume6
Issue number1
DOIs
StatePublished - Dec 1 2020

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'HIV and antiretroviral therapy-related fat alterations'. Together they form a unique fingerprint.

  • Cite this

    Koethe, J. R., Lagathu, C., Lake, J. E., Domingo, P., Calmy, A., Falutz, J., Brown, T. T., & Capeau, J. (2020). HIV and antiretroviral therapy-related fat alterations. Nature Reviews Disease Primers, 6(1), [48]. https://doi.org/10.1038/s41572-020-0181-1