Pathogenesis and treatment of HIV lipohypertrophy.
Pathogenesis and treatment of HIV lipohypertrophy.
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DOI：
10.1097/qco.0b013e3283420eef
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发表时间：
2011-02
影响因子：
3.9
通讯作者：
Glesby MJ
中科院分区：
文献类型：
--
作者：
Leung VL;Glesby MJ
这篇综述阐述了我们目前对HIV相关脂肪肥大发病机制的理解，并描述了一种基于证据的治疗方法。尽管HIV相关的脂肪肥大的发病机制仍然难以捉摸，但最近在脂肪酸代谢和生长激素动力学方面的临床和实验室研究进一步加深了我们对这种情况的理解。这些发现也为新的治疗干预铺平了道路，其中，替沙莫瑞林，一种生长激素释放激素的类似物，已经被认为是一种有希望的治疗内脏脂肪堆积的策略。最近的随机安慰剂对照试验表明，替沙莫林能显著减少内脏脂肪组织，改善脂质参数，对葡萄糖耐量无不良影响。然而，最佳治疗剂量和治疗时间尚不清楚。使用ghrh类似物治疗是否会改善长期代谢和心血管结果还有待观察。尽管HIV脂肪肥大的发病机制尚不清楚，但一些理论和观察已经导致了对抗脂肪积累及其伴随的代谢并发症的治疗策略的发展。根据临床试验，GH/GHRH轴的类似物似乎在减少内脏脂肪组织方面最有效。
This review addresses our current understanding of the pathogenesis of HIV associated lipohypertrophy, and describes an evidence-based approach to treatment. Although the pathogenesis of HIV associated lipohypertrophy remains elusive, recent clinical and laboratory investigations in fatty acid metabolism and growth hormone dynamics have furthered our understanding of the condition. These findings have also paved the way for new therapeutic interventions, of which tesamorelin, an analogue of growth hormone-releasing hormone, has gained recognition as a promising treatment strategy against visceral fat accumulation. Recent randomized placebo-controlled trials of tesamorelin demonstrated significant reductions in visceral adipose tissue, improvement in lipid parameters, and no adverse effects on glucose tolerance. Optimal therapeutic dosing and treatment duration, though, are not yet known. Whether treatment with GHRH-analogues will translate into improved long-term metabolic and cardiovascular outcomes also remains to be seen. Although the pathogenesis of HIV lipohypertrophy remains unclear, several theories and observations have led to the development of treatment strategies to counter fat accumulation and its accompanying metabolic complications. Based on clinical trials, analogues of the GH/GHRH axis appear to be most effective in reducing visceral adipose tissue.