Update on metabolic issues in HIV patients

Purpose of review To report on the recent advances on lipids, diabetes, and body fat in HIV-infected patients from the perspective of aging. Recent findings HIV infection causes microbial translocation and inflammation that contribute to hypertriglyceridemia and insulin resistance, and quantitative and qualitative HDL-cholesterol changes that further contributes to atherosclerosis. These changes are incompletely reversed by antiretroviral therapy. Protease inhibitors have the worse lipid profile among the currently used antiretroviral drugs. Etravirine, maraviroc, and raltegravir have a lipid impact better than other antiretroviral classes. The importance of genetic background on dyslipidemia of HIV-infected patients is becoming increasingly known. Lipodystrophy is associated with inflammation, dyslipidemia, diabetes, hypertension, and functional decline. Lipohypertrophy is becoming more common in HIV-infected patients influenced by the current obesity epidemics in the general population. Summary Inflammation, cholesterol abnormalities, and lipodystrophy caused by both HIV infection and antiretroviral therapy may pose aging HIV-infected patients at a higher risk of comorbidities and frailty despite sustained viral suppression. Healthier lifestyles and strategies specifically addressed to diminish the impact of these pathophysiologic abnormalities will be needed for preserving the overall health in aging HIV-infected persons.