脂肪分佈異位與人類免疫缺乏病毒感染

Lipodystrophy and Human Immunodeficiency Virus Infection

蘭淑貞(Shu-Jan Lan)

《中華民國營養學會雜誌》 27卷3期 (2002/09) Pp. 118-128

https://doi.org/10.6691/JCNS.200209_27(3).0001

摘要

人類免疫缺乏病毒（human immunodeficiency virus, HIV）〔簡稱愛滋病毒〕暨人類免疫缺乏症候群（acquired human immunodeficiency syndrome, AIDS）〔簡稱愛滋病〕（HIV／AIDS）為世界性健康問題，死亡率高居第一位。抗HIV藥物的開發與使用快速降低HIV／AIDS罹病率與死亡率，卻產生「脂肪分佈異位」(lipodystrophy)副作用，此為近兩三年歐美澳地區最熱門議題。本文就脂肪分佈異位做一綜論性報告包括：世界和台灣HIV／AIDS流行現況；脂肪分佈異位之定義、分類與特徵；脂肪分佈異位在HIV感染者之發生率；與HIV感染者脂肪分佈異位有關之因素包括HIV、抗HIV藥物包括蛋白?抑制劑、核?酸反轉錄?抑制劑、非核?酸反轉錄?抑制劑與其他藥物、用藥時間與對藥物耐受性、性別、身體質量指數（BMI）與身體組成、年齡、免疫功能、賀爾蒙、飲食／營養狀況、運動；脂肪分佈異位對HIV感染者的影響；治療脂肪分佈異位方法包括停藥或轉換療法、飲食／營養療法、運動療法、降血脂、血糖藥物療法，荷爾蒙療法與整形手術-抽脂術或脂肪移植。對脂質代謝異常、血糖上升、胰島素抗性或糖尿病患者，除了採用飲食／營養療法與運動療法外，可同時採用降血脂、血糖藥物療法。

關鍵字

脂肪分佈異位 ； 人類免疫缺乏病毒 ； 愛滋病毒 ； 人類免疫缺乏症候群 ； 愛滋病 ； 抗病毒藥物

並列摘要

Human immunodeficiency virus (HIY)/acquired human immunodeficiency syndrome (AIDS) is a major public health problem worldwide, since it is the number one leading cause of death in certain underdeveloped countries. Although many anti-HIV drugs, which dramatically decrease morbidity and mortality associated with HIV / AIDS, are available in developed countries, long-term use of these drugs has been associated with the undesirable side effect of lipodystrophy, a very hot issue over the past 2~3 years in those countries. This review includes the following: 1) a review of the epidemic of HIV / AIDS in Taiwan as well as worldwide; 2) a definition, classification, and the characteristics of lipodystrophy; 3) the prevalence of lipodystrophy in people living with HIV (PLWH); 4) factors associated with lipodystrophy in PLWH such as HIV, antiretroviral drugs including protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTIs), non nucleoside reverse transcriptase inhibitors (NNRTIs), and other drugs; the duration of drug therapy and drug tolerability, gender, body mass index (8MI) and body composition, age, immunity, hormones, diet/nutrition, and exercise: 5) the influence of lipodystrophy on PLWH; and 6) treatments for lipodystrophy including switching therapies or stopping drugs, diet/nutrition therapies, exercise, drug therapies to lower blood lipid or glucose, hormonal therapy , and plastic surgery such as liposuction, lipectomy or fat grafts. For those with dyslipidemia, hyperglycemia, insulin resistance, or diabetes mellitus, in addition to the therapies of diet/nutrition and exercise, blood lipid- or glucose-lowering drugs can be used.

並列關鍵字

lipodystrophy ； human immunodeficiency virus ； HIV ； acquired human immunodeficiency syndrome ； AIDS ； antiretroviral drugs