Over the past 4 decades, the clinical care of people living with HIV (PLWH) evolved from treatment of acute opportunistic infections to the management of chronic, noncommunicable comorbidities. Concurrently, our understanding of adipose tissue function matured to acknowledge its important endocrine contributions to energy balance. PLWH experience changes in the mass and composition of adipose tissue depots before and after initiating antiretroviral therapy, including regional loss (lipoatrophy), gain (lipohypertrophy), or mixed lipodystrophy. These conditions may coexist with generalized obesity in PLWH and reflect disturbances of energy balance regulation caused by HIV persistence and antiretroviral therapy drugs. Adipocyte hypertrophy characterizes visceral and subcutaneous adipose tissue depot expansion, as well as ectopic lipid deposition that occurs diffusely in the liver, skeletal muscle, and heart. PLWH with excess visceral adipose tissue exhibit adipokine dysregulation coupled with increased insulin resistance, heightening their risk for cardiovascular disease above that of the HIV-negative population. However, conventional therapies are ineffective for the management of cardiometabolic risk in this patient population. Although the knowledge of complex cardiometabolic comorbidities in PLWH continues to expand, significant knowledge gaps remain. Ongoing studies aimed at understanding interorgan communication and energy balance provide insights into metabolic observations in PLWH and reveal potential therapeutic targets. Our review focuses on current knowledge and recent advances in HIV-associated adipose tissue dysfunction, highlights emerging adipokine paradigms, and describes critical mechanistic and clinical insights.

中文翻译：

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HIV 感染者的脂肪组织功能障碍和能量平衡范式。


过去 4 年来，艾滋病毒感染者 (PLWH) 的临床护理从急性机会性感染的治疗发展到慢性非传染性合并症的治疗。与此同时，我们对脂肪组织功能的理解逐渐成熟，认识到其对能量平衡的重要内分泌贡献。感染者在开始抗逆转录病毒治疗前后，脂肪组织库的质量和成分会发生变化，包括区域性损失（脂肪萎缩）、增加（脂肪肥大）或混合性脂肪营养不良。这些情况可能与感染者的普遍肥胖共存，反映了艾滋病毒持续存在和抗逆转录病毒治疗药物引起的能量平衡调节紊乱。脂肪细胞肥大的特征是内脏和皮下脂肪组织库扩张，以及广泛发生在肝脏、骨骼肌和心脏中的异位脂质沉积。内脏脂肪组织过多的感染者表现出脂肪因子失调和胰岛素抵抗增加，使他们患心血管疾病的风险高于艾滋病毒阴性人群。然而，传统疗法对于控制该患者群体的心脏代谢风险无效。尽管对感染者复杂心脏代谢合并症的了解不断扩大，但仍然存在重大知识差距。正在进行的旨在了解器官间通讯和能量平衡的研究为了解 PLWH 的代谢观察提供了见解，并揭示了潜在的治疗靶点。我们的综述重点关注艾滋病毒相关脂肪组织功能障碍的当前知识和最新进展，强调新兴的脂肪因子范式，并描述关键的机制和临床见解。