Content

The wily human immunodeficiency virus (HIV-1) has another trick up its sleeve, one that can disrupt cellular metabolism and raise the risk of heart disease, diabetes and osteoporosis in patients already receiving treatment to fight HIV, said researchers led by those at Baylor College of Medicine in a report that appears online in the journal Science Translational Medicine.

The culprit is an HIV-1 accessory protein known as viral protein R (Vpr). The findings reported by the researchers answer some of the questions as to why patients receiving successful treatment for HIV end up with abnormal fat loss and deposits – a problem call lipodystrophy.

“With antiretroviral treatment, HIV has become a chronic illness, and lipodystrophy and associated metabolic defects have become, long-term, serious complications,” said Dr. Ashok Balasubramanyam, professor of medicine – endocrinology, diabetes and metabolism at BCM. “It appears that latent or hidden HIV is dangerous not only because it can flare up if treatment is interrupted, but also because it keeps producing toxic signals that make HIV disease (despite the best antiviral treatment) a chronic, metabolically debilitating illness with high risk of diabetes, cardiovascular disease and obesity. This adds to the urgent need for a real cure for HIV, i.e., ways of wiping out all traces of HIV even in reservoirs where it currently hides out.”

Because the HIV lipodystrophy syndrome was first noticed around the time that the successes of anti-retroviral drugs became apparent, most clinicians assumed that the drugs were the cause. However, research shows that while the drugs may play a role, some of the problems with lipids in the blood and glucose levels and diseases associated with those problems continue, even if the drugs are changed or newer drugs are used. Fat metabolic defects also exist in patients who are untreated or have a genetic quirk that prevents the virus from destroying their immune systems after infection.