Jordan E Lake1, Takara L Stanley2, Caroline M Apovian3,4, Shalendar Bhasin3, Todd T Brown5, Jaqueline Capeau6, Judith S Currier7, Michael P Dube8, Julian Falutz9, Steven K Grinspoon10, Giovanni Guaraldi11, Esteban Martinez12, Grace A McComsey13, Fred R Sattler8, Kristine M Erlandson14. 1. Department of Medicine, University of Texas Health Science Center at Houston. 2. Department of Pediatrics, Harvard University School of Medicine and. 3. Departments of Medicine and. 4. Pediatrics, Boston University School of Medicine, Massachusetts. 5. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland. 6. Department of Cell Biology and Metabolism, Univ-Paris 6, Inserm UMRS938, ICAN, Paris, France. 7. Department of Medicine, University of California Los Angeles and. 8. Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles. 9. Department of Medicine, McGill University, Montreal, Quebec, Canada. 10. Department of Medicine, Harvard University School of Medicine, Boston, Massachusetts. 11. Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy. 12. Department of Medicine, University of Barcelona, Spain. 13. Department of Medicine and Pediatrics, Case Western University, Cleveland, Ohio; and. 14. Department of Medicine, University of Colorado School of Medicine, Aurora.
Abstract
BACKGROUND: Obesity and lipohypertrophy are common in treated human immunodeficiency virus (HIV) infection and contribute to morbidity and mortality among HIV-infected adults on antiretroviral therapy (ART). METHODS: We present a consensus opinion on the diagnosis, clinical consequences, and treatment of excess adiposity in adults with treated HIV infection. RESULTS: Obesity and lipohypertrophy commonly occur among HIV-infected adults on ART and may have overlapping pathophysiologies and/or synergistic metabolic consequences. Traditional, HIV-specific, and ART-specific risk factors all contribute. The metabolic and inflammatory consequences of excess adiposity are critical drivers of non-AIDS events in this population. Although promising treatment strategies exist, further research is needed to better understand the pathophysiology and optimal treatment of obesity and lipohypertrophy in the modern ART era. CONCLUSIONS: Both generalized obesity and lipohypertrophy are prevalent among HIV-infected persons on ART. Aggressive diagnosis and management are key to the prevention and treatment of end-organ disease in this population and critical to the present and future health of HIV-infected persons.
BACKGROUND: Obesity and lipohypertrophy are common in treated human immunodeficiency virus (HIV) infection and contribute to morbidity and mortality among HIV-infected adults on antiretroviral therapy (ART). METHODS: We present a consensus opinion on the diagnosis, clinical consequences, and treatment of excess adiposity in adults with treated HIV infection. RESULTS: Obesity and lipohypertrophy commonly occur among HIV-infected adults on ART and may have overlapping pathophysiologies and/or synergistic metabolic consequences. Traditional, HIV-specific, and ART-specific risk factors all contribute. The metabolic and inflammatory consequences of excess adiposity are critical drivers of non-AIDS events in this population. Although promising treatment strategies exist, further research is needed to better understand the pathophysiology and optimal treatment of obesity and lipohypertrophy in the modern ART era. CONCLUSIONS: Both generalized obesity and lipohypertrophy are prevalent among HIV-infected persons on ART. Aggressive diagnosis and management are key to the prevention and treatment of end-organ disease in this population and critical to the present and future health of HIV-infected persons.
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