Metabolic complications associated with use of HIV protease inhibitors

The potency of highly active antiretroviral therapy, including protease inhibitors have led to declining morbidity and mortality in patients with HIV infection. However the use of protease inhibitors is associated with onset of morphologic and metabolic disorders. A syndrome of lipodystrophy has been described. It is characterized by fast wasting of the face and limbs, and a central adiposity, breast hypertrophy and buffalo neck. The prevalence of lipodystrophy in patients treated with protease inhibition is about 60%. The principal metabolic disorders are lipid abnormalities, principally hypertriglyceridemia. New onset of diabetes mellitus is less frequent. The pathogenesis of these abnormalities unknown. Insulin resistance seems to be a common feature of protease inhibitor associated metabolic an morphologic: side-effects.