Pathogenesis and epidemiology of metabolic abnormalities

The metabolic and morphologic abnormalities that complicate the management of HIV infection include dyslipidemia, insulin resistance, peripheral fat wasting, central fat accumulation, lactic acidemia and acidosis, reduced bone mineral density, and avascular necrosis of hip and shoulder.

The interrelationship between these clinical problems and the roles of specific antiretroviral agents and HIV infection itself in their pathogenesis have been the focus of intensive clinical investigation for several years.

Concern over the long-term sequelae of these metabolic abnormalities (in particular, cardiovascular risk) has led both clinicians and patients to consider deferring antiretroviral therapy. This review focuses on the epidemiology and pathogenesis of changes in lipids, glucose, and body shape.

In addition, data on the direct effects of antiretroviral agents on these changes are reviewed, and proposed mechanisms promoting specific metabolic complications are highlighted.