Información del artículo
El tratamiento antirretroviral combinado y la propia infección por el virus de la inmunodeficiencia humana (VIH) se asocian a varios trastornos metabólicos como la lipodistrofia, la dislipemia, la resistencia a la insulina, la arteriosclerosis subclínica, la hipertensión y las alteraciones del metabolismo óseo. La possible etiopatogenia se relaciona con alteraciones en el ADN mitocondrial, en la diferenciación y función de los adipocitos e inhibición de los transportadores de membrana de glucosa. Las dislipemias son causadas por la inhibición de las lipasas endoteliales, por el incremento de síntesis de la apoproteína B y la disminución de la expresión del receptor de las lipoproteínas de baja densidad. Sin embargo, antirretrovirales como el efavirenz incrementan las concentraciones del colesterol transportado por las lipoproteínas de alta densidad en más de un 30%. Aunque la terapia antirretroviral puede inducir disfunción endotelial, la arteriosclerosis subclínica parece estar más relacionada con el proceso inflamatorio e inmunitario. La hipertensión y el trastorno del metabolismo óseo se asocian al tiempo de exposición acumulado del tratamiento antirretroviral. Las causas de las alteraciones metabólicas en el síndrome de la inmuodeficiencia adquirida (sida) son múltiples y complejas, y todavía no existen soluciones satisfactorias para éstas.
Palabras clave:
VIH
Alteraciones metabólicas
Arteriosclerosis
Terapia antirretroviral
Combination antiretroviral therapy and human immunodeficiency virus (HIV) infection are associated with several metabolic disorders such as lipodystrophy, dyslipidemia, insulin resistance, subclinical arteriosclerosis, hypertension, and bone metabolism alterations. The pathogenesis may be related to alterations in mitochondrial DNA and adipocyte differentiation and function and inhibition of glucose membrane transporters. Dyslipidemia is caused by inhibition of endothelial lipase, increased apolipoprotein B synthesis, and a reduction in low-density lipoprotein receptor expression. Antiretroviral drugs such as efavirenz increase the concentrations of cholesterol transported by high-density lipoprotein by more than 30%. Although antiretroviral therapy can induce endothelial dysfunction, subclinical arteriosclerosis seems to be more closely related to the inflammatory and immune process. Hypertension and bone metabolism disorders are associated with the cumulative time of exposure to antiretroviral therapy. The causes of metabolic alterations in aids are multiple and complex and satisfactory solutions are still lacking.
Key words:
HIV
Metabolic alterations
Arteriosclerosis
Antiretroviral therapy
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