Sida, antirretrovirales y alteraciones metabólicas complejas

Combination antiretroviral therapy and human immunodeficiency virus (HIV) infection are associated with several metabolic disorders such as lipodystrophy, dyslipidemia, insulin resistance, subclinical arteriosclerosis, hypertension, and bone metabolism alterations. The pathogenesis may be related to alterations in mitochondrial DNA and adipocyte differentiation and function and inhibition of glucose membrane transporters. Dyslipidemia is caused by inhibition of endothelial lipase, increased apolipoprotein B synthesis, and a reduction in low-density lipoprotein receptor expression. Antiretroviral drugs such as efavirenz increase the concentrations of cholesterol transported by high-density lipoprotein by more than 30%. Although antiretroviral therapy can induce endothelial dysfunction, subclinical arteriosclerosis seems to be more closely related to the inflammatory and immune process. Hypertension and bone metabolism disorders are associated with the cumulative time of exposure to antiretroviral therapy. The causes of metabolic alterations in aids are multiple and complex and satisfactory solutions are still lacking.