HypothesisHIV-associated adipose redistribution syndrome as a selective autonomic neuropathy
Section snippets
Background
Body-fat redistribution in HARS entails disproportional desposition of intra-abdominal adipose tissue and wasting of subcutaneous fat, especially in the extremities, buttocks, and face. Initially, the syndrome was solely linked to use of protease inhibitors, but the present idea is that both protease inhibitors and nucleoside reverse transcriptase inhibitors contribute to the syndrome, although in-vitro evidence is sparse for nucleoside reverse transcriptase inhibitors.4, 5 HARS was initially
Hypothesis
HARS is a disorder resulting from selective damage by antiretroviral drugs to autonomic pathways in the CNS, innervating either the subcutaneous or visceral fat depots. Specifically, increased sympathetic over parasympathetic tone of subcutaneous fat innervation induces selective loss of subcutaneous fat, and decreased sympathetic over parasympathetic tone of visceral fat innervation induces accumulation of intra-abdominal fat. The damage might be reversible (altered neuronal function) or
Testing the hypothesis
For antiretroviral agents to affect autonomic neurons within the CNS they must enter the brain. Experiments in rats exposed to different combinations of antiretroviral drugs including protease inhibitors and nucleoside reverse transcriptase inhibitors should assess their penetration in dissected and homogenised hypothalamus and brainstem areas containing, respectively, the preautonomic and autonomic motor neurons. Furthermore, stereotaxic local administration of antiretroviral agents in the
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Cited by (49)
Procedure, applications, and outcomes of autologous fat grafting
2017, Annals of Medicine and SurgeryCitation Excerpt :The redistribution of fat deposits in HIV-associated lipodystrophy includes visceral fat accumulation in the abdomen and subcutaneous fat accumulation in the breasts and the cervical and dorsal areas (buffalo hump) with fat wasting in the legs, arms, buttocks, and face [100]. Many hypotheses have been proposed for its aetiology: most of them focus on the mitochondrial toxic effects and altered adipocyte differentiation induced by protease inhibitors and nucleoside reverse transcriptase inhibitors [100–102], but lipodystrophy has also been represented as a selective neuropathy [100,103]. Following the consistent experience of Coleman in facial lipofilling for aesthetic purposes [2,100,104], autologous fat injection has been considered as one of the most reliable treatments for facial subcutaneous augmentation.
Effects of microvascular complications on structural changes in visceral and subcutaneous adiposity among type 2 diabetes patients
2016, Obesity MedicineCitation Excerpt :Not only sympathetic activation but also parasympathetic activation, for which CVRR is a typical surrogate marker, is thought to increase metabolism, or energy expenditure, which in turn affects body weight (Messina et al., 2013). Parasympathetic innervation is thought to have an anabolic effect on white adipose tissue in HIV-1-associated adipose redistribution syndrome (Fliers et al., 2003). In addition, the vagus nerve can regulate visceral and subcutaneous fat volumes, based on data obtained from patients of distal gastrectomy (Miyato et al., 2012).
Lipodystrophy and adrenal insufficiency: Potential mediators of peripheral neuropathy in HIV infection?
2012, Medical HypothesesCitation Excerpt :Lipid has insulation potentials and is the principal shock-absorbing component of the human body that protects from physical trauma [38]. However, lipid molecules are mobilized from the periphery to the central part of the body in lipodystrophy [39], which is believed to be due to excessive levels of steroids (owing to peripheral steroid resistance) besides certain other neural, endocrinal factors, as proposed by others [40]. Adipocytes, the bulk ingredient of the epineurial compartment, are important for the normal functions of mature nerve fibres [37].
Sympathetic and sensory innervation of white adipose tissue
2007, Journal of Lipid ResearchCitation Excerpt :In addition, certain pathological conditions associated with lipodystrophies also might have the SNS innervation of WAT as an underlying cause or contributor. For example, it was postulated (238) that the lipodystrophy accompanying the late stages of acquired immunodeficiency syndrome, the so-called human immunodeficiency virus (HIV)-associated adipose redistribution syndrome, may have increased sympathetic drive as its basis. Indeed, patients with HIV-1 infection and HIV-associated adipose redistribution syndrome have increased subcutaneous WAT NE concentration without increases in global sympathetic nerve activity (239).