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Effects of sex and race on lipodstrophy pathogenesis

Mediscript Ltd
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  • Medicine


Advanced Studies in Medicine � S981 ABSTRACT HIV-infected patients who are naive to anti- retroviral therapy usually demonstrate decreased lipid levels as a consequence of infection. Treatment with antiretroviral agents may be gen- erally associated with a “return-to-baseline phe- nomenon” that should be considered when evaluating clinical trial findings. The older pro- tease inhibitors (PIs)—saquinavir, indinavir, riton- avir, nelfinavir, and amprenavir—have been associated with the development of hypertriglyc- eridemia, insulin resistance, and dyslipidemia. New PIs have been developed that have more favorable lipid profiles, offer more dosing options, and are associated with fewer short-term side effects. This article summarizes the compli- cations associated with the older and newer PIs and offers guidance for the clinical management of metabolic complications in patients taking anti- retroviral therapy. (Adv Stud Med. 2003;3(10B):S981-S986) T o put lipid-related complications seen in HIV-infected persons in proper context, one must consider the epidemic of the metabolic syndrome occurring in the healthy, HIV-uninfected populations of the developed world. This syndrome is associated with visceral obesity, high lipid levels, and insulin resis- tance, factors found to be the main drivers of cardio- vascular risk. HIV infection itself may actually abrogate many of these factors, providing a variable degree of “protection” to infected individuals via favor- able lipid changes. Antiretroviral drug therapy can result in a trend returning toward baseline values and lead to fat accumulation and visceral obesity. It is important to keep this in mind when considering lipid data from clinical trials. Baseline factors that are pre- dictive for cardiovascular disease include sex, ethnicity, and increasing age. In addition, time-related factors, such as duration of exposure to antiretroviral agents, also contribute to the risk. The risk factors may be divided into those that are modifiable and thos

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