RUDN Journal of MedicineRUDN Journal of MedicineВестник Российского университета дружбы народов. Серия: Медицина2313-02452313-0261Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)1843810.22363/2313-0245-2018-22-1-50-56IMMUNOLOGY. INFECTIOUS PATHOLOGYИММУНОЛОГИЯ. ИНФЕКЦИОННАЯ ПАТОЛОГИЯResearch ArticleCauses for the development of lipodystrophy among HIV and AIDS patientsПричины развития липодистрофии у ВИЧ/СПИД больныхAzovtsevaO VАзовцеваОльга Владимировна

Ph.D. Associate Professor of the Department of Microbiology, Immunology and Infectious Diseases of Novgorod State University named after Yaroslav the Wise

к.м.н., доцент кафедры микробиологии, иммунологии и инфекционных болезней Новгородского государственного университета имени Ярослава Мудрого

olga-azovtseva@mail.ruBelousM KБелоусМ Кolga-azovtseva@mail.ruYaroslav-the-Wise Novgorod State UniversityФедеральное государственное бюджетное образовательное учреждение высшего образования «Новгородский государственный университет имени Ярослава Мудрого»15122018221VOL 22, NO1 (2018)ТОМ 22, №1 (2018)505601052018Copyright ©; 2018, Azovtseva O.V., Belous M.K.Copyright ©; 2018, Азовцева О.В., Белоус М.К.2018Azovtseva O.V., Belous M.K.Азовцева О.В., Белоус М.К.http://creativecommons.org/licenses/by/4.0https://journals.rudn.ru/medicine/article/view/18438

Today, about 35 million people worldwide are infected with HIV. These patients often develop lipid metabolism disorder called lipodystrophy syndrome. Various clinical features of lipodystrophy are peripheral fat loss in the lower limbs, face and buttocks (lipoatrophy); central adiposity, i.e. excess fat accumulation in the abdomen, breasts or dorsocervical region (lipohypertrophy); lipoma development. These types of redistribution of the adipose tissue occur in isolation as well as combined. The article examines the following causes of the development of lipodystrophy: HIV-associated lipodystrophy, HAART-associated lipodystrophy and lipodystrophy caused by age-related changes. It is also pointed out that redistribution of the adipose tissue is more common among the HIV-patients who have had PI-based ART or nucleoside reverse transcriptase inhibitors-based ART (NRTIs).

Эпидемия ВИЧ-инфекции охватила весь мир. У данных пациентов широко распространены нарушения липидного обмена. Существуют различные клинические варианты развития липодистрофии: истощение переферического жира на лице, конечностях и ягодицах (липоатрофия); центральный тип ожирения - избыточное накопление жировой ткани в области живота, молочных желез и дорсоцервикальной области (липогипертрофия); развитие липом. Данные перераспределение жировой ткани встречаются как по отдельности, так и в сочетании между собой. В обзоре рассмотрены причины развития липодистрофий вследствие воздействия самой ВИЧ-инфекции, применяемых антиретровирусных препаратов и возрастных изменений пациентов. Отмечено, что на фоне использования антиретровирусных препаратов перераспределение жировой ткани у ВИЧ-инфицированных встречается чаще на фоне приема ингибиторов протеазы и нуклеозидных ингибиторов обратной транскриптазы.

HIV infectionlipodystrophy syndromeantiretroviral therapy (ART)ВИЧ-инфекциялиподистрофический синдромантиретровирусная терапияPokrovsky VV, Ladnaya NN, Tushina OI, Buravtsova EV HIV Infection: Fact Sheet No. 40. M.: Federal Scientific and Methodological Center for AIDS Prevention and Control, 2015. 57 p.Покровский В.В., Ладная Н.Н., Тушина О.И., Буравцова Е.В. ВИЧ-инфекция: Информационный бюллетень № 40. М.: Федеральный научно-методический центр по профилактике и борьбе со СПИДом, 2015. 57 с.Melnikov VL, Aftaeva LN, Rybalkin SB, Mitrofanova NN Clinical and epidemiological features of HIV infection depending on the level of CD4 cells. Medical sciences. Hygiene and organization of public health. 2016. No. 3 (39). C. 113—118.Мельников В.Л., Афтаева Л.Н., Рыбалкин С.Б., Митрофанова Н.Н. Клинико-эпидемиологические особенности ВИЧ-инфекции в зависимости от уровня СD4-клеток // Медицинские науки. Гигиена и организация здравоохранения. 2016. № 3 (39). C. 113-118.Dvorak SI, Kryga LN, Vinogradova TN, Safonova PV, Zholobov VE, Plavinsky SL, Rassokhin VV Medico-social features of the “aging” of the HIV epidemic in St. Petersburg. HIV infection and immunosuppression. 2013. T. 5, No. 4. P. 82—89.Дворак С.И., Крыга Л.Н., Виноградова Т.Н., Сафонова П.В., Жолобов В.Е., Плавинский С.Л., Рассохин В.В. Медико-социальные особенности «старения» эпидемии ВИЧ-инфекции в Санкт-Петербурге // ВИЧ-инфекция и иммуносупрессии. 2013. Т. 5, № 4. С. 82-89.Freitas P., Carvalho D. Lipodystrophy: beyond generalization? Panminerva Med. 2013; 55: 253—268.Freitas P., Carvalho D. Lipodystrophy: beyond generalization? Panminerva Med. 2013; 55: 253-268.Carr A., Samaras K., Burton S., Law M., Freund J., Chisholm D.J. et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998; 12; F5-8.Grinspoon S., Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. NEJM 2005; 352 (1): 48—62.Grinspoon S., Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. NEJM 2005; 352(1):48-62.Heath K.V., Hogg R.S., Chan K.J. et al. Lipodystrophy-associated morphological, cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database. AIDS 2001; 15 (2): 231—9.Heath K.V., Hogg R.S., Chan K.J. et al. Lipodystrophy-associated morphological, cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database. AIDS 2001;15(2):231-9.Joly V., Flandre P., Meiffredy V. et al. Increased risk of lipoatrophy under stavudine in HIV-1-infected patients: results of a substudy from a comparative trial. Aids 2002; 16 (18): 2447—54.Joly V., Flandre P., Meiffredy V. et al. Increased risk of lipoatrophy under stavudine in HIV-1-infected patients: results of a substudy from a comparative trial. Aids 2002;16(18):2447-54.Sellmeyer D.E., Grunfeld C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr Rev. 1996; 17: 518—532.Sellmeyer D.E., Grunfeld C. Endocrine and metabolic disturbances in human immunodeficiency virus infection and the acquired immune deficiency syndrome. Endocr Rev. 1996; 17: 518-532.Hammond E., Nolan D., McKinnon E. et al. Assessing the contribution of ART, HIV and host factors to adipose tissue changes in HIV-infected individuals: risk profile for lipoatrophy. In: Program and Abstracts of the 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV; November 13—16, 2005; Dublin, Ireland. Supplement 3: L4, Abstract 2.Hammond E., Nolan D., McKinnon E. et al. Assessing the contribution of ART, HIV and host factors to adipose tissue changes occurring in HIV-infected individuals: risk profile for lipoatrophy. In: Program and abstracts of the 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV; November 13-16, 2005; Dublin, Ireland. Supplement 3:L4, Abstract 2.Prosperi MC, Fabbiani M., Fanti I., Zaccarelli M., Colafigli M., Mondi A., D'Avino A., Borghetti A., Cauda R., Di Giambenedetto S. Predictors of first-line antiretroviral therapy discontinuation due to drug-related adverse events in HIV-infected patients: a retrospective cohort study. BMC Infect Dis. 2012; 12: 296.Prosperi M.C., Fabbiani M., Fanti I., Zaccarelli M., Colafigli M., Mondi A., D’Avino A., Borghetti A., Cauda R., Di Giambenedetto S. Predictors of first-line antiretroviral therapy discontinuation due to drug-related adverse events in HIV-infected patients: a retrospective cohort study. BMC Infect Dis. 2012; 12: 296.Baker J., Ayenew W., Quick H., Hullsiek K.H., Tracy R., Henry K., Duprez D., Neaton J.D. High-density lipoprotein particles and markers of inflammation and thrombotic activity in patients with untreated HIV infection. J Infect Dis. 2010; 201: 285—292.Baker J., Ayenew W., Quick H., Hullsiek K.H., Tracy R., Henry K., Duprez D., Neaton J.D. High-density lipoprotein particles and markers of inflammation and thrombotic activity in patients with untreated HIV infection. J Infect Dis. 2010; 201: 285-292.Vaidya SA, Korner C., Sirignano MN, Amero M., Bazner S., Rychert J., Allen TM, Rosenberg ES, Bosch RJ, Altfeld M. Tumor necrosis factor α is associated with viral control and early disease progression in patients with HIV. J Infect Dis. 2014; 210: 1042—1046.Vaidya S.A., Korner C., Sirignano M.N., Amero M., Bazner S., Rychert J., Allen T.M., Rosenberg E.S., Bosch R.J., Altfeld M. Tumor necrosis factor α is associated with viral control and early disease progression in patients with HIV type 1 infection. J Infect Dis. 2014; 210: 1042-1046.Simha V., Garg A. Lipodystrophy: lessons in lipid and energy metabolism. Current Opinion in Lipidology 2006; 17 (2): 162—169.Simha V., Garg A. Lipodystrophy: lessons in lipid and energy metabolism. Current Opinion in Lipidology 2006; 17(2):162-169.Van Wijk J.P., Castro Cabezas M., de Koning E.J.P., Rabelink T.J., van der Geest R., Hoepelman I.M. In vivo evidence of impaired peripheral fatty acid trapping in patients with human immunodeficiency virus-associated lipodystrophy. J. Clin. Endocrinol. Metab. 2006; 90 (6): 3575—3582.Van Wijk J.P., Castro Cabezas M., de Koning E.J.P., Rabelink T.J., van der Geest R., Hoepelman I.M. In vivo evidence of impaired peripheral fatty acid trapping in patients with human immunodeficiency virus-associated lipodystrophy. J. Clin. Endocrinol. Metab. 2006; 90(6): 3575-3582.Cohen MS, Chen YQ, McCauley M., Gamble T., Hosseinipour MC, Kumarasamy N., Hakim J., Kumwenda J., Grinsztejn B., Pilotto JH, Godbole SV, Mehendale S., Chariyalertsak S., Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E., Wang L., Makhema J. Prevention of HIV-1 infection with early antiretroviral therapy. New England Journal of Medicine. 2011. No. 365. P. 493—505.Cohen M.S., Chen Y.Q., McCauley M., Gamble T., Hosseinipour M.C., Kumarasamy N., Hakim J., Kumwenda J., Grinsztejn B., Pilotto J.H., Godbole S.V., Mehendale S., Chariyalertsak S., Santos B.R., Mayer K.H., Hoffman I.F., Eshleman S.H., Piwowar-Manning E., Wang L., Makhema J. Prevention of HIV-1 infection with early antiretroviral therapy // New England Journal of Medicine. 2011. № 365. P. 493-505.Steven AS, Ellen SH, Laura S. Quality of Life Among Individuals with HIV Starting Antiretroviral Therapy in Diverse Resource-Limited Areas of the World. AIDS and Behavior. 2012. No. 16 (2). P. 266—277.Steven A.S., Ellen S.H., Laura S. Quality of Life Among Individuals with HIV Starting Antiretroviral Therapy in Diverse Resource-Limited Areas of the World // AIDS and Behavior. 2012. № 16 (2). P. 266-277.The strategic use of antiretrovirals to help end the HIV epidemic / WHO. URL: http://apps.who.int/iris/bitstream/ 10665/75184/1/9789241503921_eng.pdf? Ua = 1 (circulation date 14.10.2014).The strategic use of antiretrovirals to help end the HIV epidemic / WHO. URL: http://apps.who.int/iris/bitstream/ 10665/75184/1/9789241503921_eng.pdf?ua=1 (дата обращения 14.10.2014).Pokrovsky V.V. Tuberculosis and HIV infection — the threat of a double epidemic: speech at the All-Russian conference “Tuberculosis and HIV infection — the threat of a double epidemic. Actual issues of prevention, diagnosis and treatment”/ FNMTS on prevention and fight against AIDS. URL: http://itar-tass.com/obschestvo/ 1481670 (circulation date 02.10.2014).Покровский В.В. Туберкулез и ВИЧ-инфекция - угроза двойной эпидемии: выступление на всероссийской конференции «Туберкулез и ВИЧ-инфекция - угроза двойной эпидемии. Актуальные вопросы профилактики, диагностики и лечения» / ФНМЦ по профилактике и борьбе со СПИДом. URL: http://itar-tass.com/obschestvo/1481670 (дата обращения 02.10.2014).Fisher S.D., Miller T.L., Lipshultz S.E. Impact of HIV and highly active antiretroviral therapy on leukocyte adhesion molecules, arterial inflammation, dyslipidemia, and atherosclerosis. Atherosclerosis. 2006; 185: 1—11.Fisher S.D., Miller T.L., Lipshultz S.E. Impact of HIV and highly active antiretroviral therapy on leukocyte adhesion molecules, arterial inflammation, dyslipidemia, and atherosclerosis. Atherosclerosis. 2006;185:1-11.Bernasconi E., Boubaker K., Junghans C. et al. Abnormalities of body fat distribution in HIV-infected persons treated with antiretroviral drugs: The Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2002; 31 (1): 50—5.Bernasconi E., Boubaker K., Junghans C. et al. Abnormalities of body fat distribution in HIV-infected persons treated with antiretroviral drugs: The Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2002;31(1):50-5.Penzak S.R., Chuck S.K. Hyperlipidemia associated with HIV protease inhibitor use: pathophysiology, prevalence, risk factors and treatment. Scand. J. Infect. Dis. 2000: 32: 111—123.Penzak S.R., Chuck S.K. Hyperlipidemia associated with HIV protease inhibitor use: pathophysiology, prevalence, risk factors and treatment. Scand. J. Infect. Dis. 2000: 32:111-123.Khasanov GR Syndrome of lipodystrophy in people with HIV infection. Epidemiology and infectious diseases. Topical issues. 2014. No. 3. C. 63—69.Хасанов Г.Р. Синдром липодистрофии у больных ВИЧ-инфекцией // Эпидемиология и инфекционные болезни. Актуальные вопросы. 2014. № 3. С. 63-69.