Body shape, lipid, and cardiovascular complications of HIV therapy.

Metabolic complications of HIV therapy have emerged as a vexing problem for individuals living with HIV infection and their clinicians. These adverse effects threaten health and quality of life as well as adherence to HIV treatment. Among the most common metabolic complications confronting clinicians are body shape changes and dyslipidemia. The pathogenesis of these disorders remains elusive, challenging the development of treatment strategies particularly for fat redistribution. Switching from metabolically offensive antiretrovirals has yielded improvements in both body shape and dyslipidemia. In addition, therapeutic approaches that have been developed for the treatment of dyslipidemia in HIV-uninfected patients, can with important caveats be applied to HIV therapy-associated lipid disorders. Aggressive assessment of cardiovascular disease risk and intervention is likely to reduce the incidence of cardiovascular disorders in HIV-infected patients. Development of antiretrovirals with fewer metabolic adverse effects will reduce the incidence of these and similar disorders during HIV therapy.