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Information that has become available in the past year has resulted in heightened appreciation of the complexities involved in understanding and managing the constellation of alterations in fat distribution and glucose and lipid metabolism that have occurred in the current treatment era. Although there is ample evidence that protease inhibitors (PIs) play a role in the development of some of these alterations, it is now widely recognized that all of the changes cannot be attributed solely to PIs. Current data suggest a role for nucleoside analogue reverse transcriptase inhibitors (NRTIs) as well, with mitochondrial toxicity as an hypothesized mechanism. Cohort studies have shown that, in addition to exposure to both PI- and NRTI-containing regimens, factors such as age, body mass index, gender, race, duration of HIV infection, and effective viral suppression may also modulate risk of developing fat distribution and metabolic abnormalities. A variety of classification systems have been used, but as yet there is no consensus on a case definition. As a result, current prevalence estimates continue to vary considerably, and the interrelationships among the metabolic and fat distribution abnormalities have not been defined. In fact, it has been suggested that these changes may represent more than one syndrome. Overall, despite a major expansion of our knowledge base, the etiology, specific sites of dysregulation, clinical sequelae, and effective management strategies for these alterations remain to be identified. |
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© 7th
Conference on Retroviruses and Opportunistic Infections, |