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。


在过去的 4 年里，HIV 感染者的临床护理 （PLWH） 从急性机会性感染的治疗发展到慢性非传染性合并症的管理。同时，我们对脂肪组织功能的理解也越来越成熟，认识到其对能量平衡的重要内分泌贡献。PLWH 在开始抗逆转录病毒治疗前后脂肪组织库的质量和组成发生变化，包括区域丢失（脂肪萎缩）、增加（脂肪肥大）或混合性脂肪代谢障碍。这些情况可能与 PLWH 中的全身性肥胖共存，并反映了 HIV 持久性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，以及弥漫性发生在肝脏、骨骼肌和心脏的异位脂质沉积。内脏脂肪组织过多的 PLWH 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 HIV 阴性人群。然而，常规疗法对管理该患者群体的心脏代谢风险无效。尽管对 PLWH 中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空白。正在进行的旨在了解器官间通讯和能量平衡的研究为 PLWH 的代谢观察提供了见解，并揭示了潜在的治疗靶点。我们的综述侧重于 HIV 相关脂肪组织功能障碍的当前知识和最新进展，重点介绍了新兴的脂肪因子范式，并描述了关键的机制和临床见解。