Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virology. May 12, 2015; 4(2): 56-77
Published online May 12, 2015. doi: 10.5501/wjv.v4.i2.56
Impact of antiretroviral therapy on lipid metabolism of human immunodeficiency virus-infected patients: Old and new drugs
Joel da Cunha, Luciana Morganti Ferreira Maselli, Ana Carolina Bassi Stern, Celso Spada, Sérgio Paulo Bydlowski
Joel da Cunha, Luciana Morganti Ferreira Maselli, Ana Carolina Bassi Stern, Sérgio Paulo Bydlowski, Laboratory of Genetics and Molecular Hematology (LIM31), University of São Paulo Medical School (FMUSP), São Paulo SP 05403-000, Brazil
Joel da Cunha, Celso Spada, Clinical Analysis Department, Health Sciences Center, Federal University of Santa Catarina (CCS/UFSC), Florianópolis SC 88040-900, Brazil
Luciana Morganti Ferreira Maselli, Molecular Genetics and Biotechnology Department, Research Division, Pró-Sangue Foundation/Blood Center of São Paulo, São Paulo SP 05403-000, Brazil
Author contributions: All authors had equally contributed to this work.
Conflict-of-interest: The authors state that there are no conflicts of interest regarding the publication of this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sérgio Paulo Bydlowski, MD, PhD, Associate Professor of Hematology, Director, Laboratory of Genetics and Molecular Hematology (LIM-31), University of São Paulo Medical School (FMUSP), Av. Dr. Enéas de Carvalho Aguiar, 155, 1 andar, Sala 43, São Paulo SP 05403-000, Brazil.
Telephone: +55-11-30822398 Fax: +55-11-30822398
Received: October 27, 2014
Peer-review started: October 28, 2014
First decision: November 27, 2014
Revised: February 9, 2015
Accepted: March 5, 2015
Article in press: March 9, 2015
Published online: May 12, 2015

For human immunodeficiency virus (HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy (HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.

Keywords: Human immunodeficiency virus-1 infection, Highly active antiretroviral therapy, Protease inhibitors, Dyslipidemia, Atherosclerosis, Lipodystrophy, Statins, Fibrates, Diet, Lifestyle

Core tip: Antiretroviral therapy inhibits human immunodeficiency virus (HIV)-1 replication, reduces mortality and increases survival. On the other hand, HIV-1 infection and antiretroviral therapy affect lipid metabolism. In fact, lipodystrophy is a well-documented side effect of highly active antiretroviral therapy (HAART). Switching to a less metabolically active drug improve HAART-associated dyslipidemia. Other therapies may include statins, fibrates, inhibitors cholesterol absorption, fish oils, niacin. Moreover, changes in diet and lifestyle are needed to revert the dyslipidemia.