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    Sekhar, Rajagopal V. 2015. Treatment of Dyslipidemia in HIV. Current Atherosclerosis Reports, Vol. 17, Issue. 4,


    Sekhar, Rajagopal V and Balasubramanyam, Ashok 2010. Treatment of dyslipidemia in HIV-infected patients. Expert Opinion on Pharmacotherapy, Vol. 11, Issue. 11, p. 1845.


    2004. Position of the American Dietetic Association and Dietitians of Canada: Nutrition Intervention in the Care of Persons with Human Immunodeficiency Virus Infection. Journal of the American Dietetic Association, Vol. 104, Issue. 9, p. 1425.


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  • Proceedings of the Nutrition Society, Volume 61, Issue 1
  • February 2002, pp. 131-136

The paradox of improved antiretroviral therapy in HIV: potential for nutritional modulation?

  • Lisa J. Ware (a1) and S. A. Wootton (a1)
  • DOI: http://dx.doi.org/10.1079/PNS2001139
  • Published online: 01 February 2007
Abstract

Chronic infection with HIV type 1 is associated with alterations in macronutrient metabolism, specifically elevated plasma lipids, glucose and reduced insulin sensitivity. These alterations are most severe in patients at the later stages of AIDS, indicating a relationship with disease progression. Recently, a metabolic syndrome, termed lipodystrophy, has been described in successfully-treated HIV patients in whom the altered macronutrient metabolism of HIV infection appears to be amplified markedly, with concurrent alterations in adipose tissue patterning. This syndrome presents a paradox, as before the development of highly-active antiretroviral therapy (HAART) the most severe perturbations in metabolism were observed in the sickest patients. Now, the patients that respond well to therapy are showing metabolic perturbations much greater than those seen before. The implications of this syndrome are that, whilst life expectancy may be increased by reducing viral load, there are concomitant increases in the risk of cardiovascular disease, diabetes and pancreatitis within this patient population. The aetiology of the syndrome remains unclear. In a collaborative trial with the Chelsea and Westminster Hospital in London we have used stable-isotope-labelled fatty acids to examine the hypothesis that treatment with HAART causes a delayed clearance of dietary lipid from the circulation, resulting in the retention of lipid within plasma and the downstream changes in insulin and glucose homeostasis. This hypothesis would indicate a role for low-fat diets, exercise and drugs that reduce plasma lipid or insulin resistance, in modulating the response to antiretroviral therapy in HIV infection.

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Copyright
Corresponding author
*Corresponding Author: Lisa Ware, present address SHS International Ltd, 100 Wavertree Boulevard, Liverpool L7 9PT, UK, fax +44 (0)151 228 2650, email lware@shsint.co.uk
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Proceedings of the Nutrition Society
  • ISSN: 0029-6651
  • EISSN: 1475-2719
  • URL: /core/journals/proceedings-of-the-nutrition-society
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