a1 Diabetes and Nutritional Sciences Division, School of Medicine, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK
HIV-associated lipodystrophy syndrome (HALS), comprising metabolic and morphological alterations, is a known side effect of highly active antiretroviral therapy (HAART). Evidence for the role of nutrition in the management of the systemic parameters of HALS is currently limited. In the present paper we review the current knowledge base surrounding HALS, focusing particularly on the role of nutrition in mitigating the systemic parameters of the syndrome. Reported prevalence of HALS was found to vary from 9 to 83 % due to lack of a standardised definition, as well as variations in assessment methods and in the study population used. HALS is associated with both morphological (lipoatrophy, lipohypertrophy) and metabolic (dyslipidaemia, glucose intolerance, diabetes, hypertension, endothelial dysfunction and atherosclerosis) alterations, which may occur singly or in combination, and are associated with an increased risk of CVD. HAART-induced adipocyte inflammation, oxidative stress and macrophage infiltration, as well as altered adipocyte function and mitochondrial toxicity, have been shown to be central to the development of HALS. The adipocyte, therefore, represents a plausible target for treatment. Pharmacological and surgical treatment interventions have shown effect. However, their use is associated with numerous adverse effects and complications. Targeted lifestyle interventions may provide a useful alternative for managing HALS owing to their safety and tolerability. A Mediterranean-style diet has been found to be effective in improving the systemic parameters of HALS. Furthermore, the effects of n-3 PUFA supplementation are encouraging and future randomised controlled trials investigating the beneficial effects of n-3 PUFA in HALS are justified.
(Received March 25 2011)
(Revised June 19 2012)
(Accepted July 12 2012)
Abbreviations: ART, antiretroviral therapy; cART, combination antiretroviral therapy; CT, computed tomography; d4T, stavudine; HALS, HIV-associated lipodystrophy syndrome; LA, lipoatrophy; LH, lipohypertrophy; MI, myocardial infarction; n-3 LC-PUFA, n-3 long-chain PUFA; NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III; NNRTI, non-nucleoside RT inhibitor; NRTI, nucleoside RT inhibitor; PI, protease inhibitor; REE, resting energy expenditure; T2DM, type 2 diabetes mellitus; ZDV, zidovudine