Resistência à insulina e diabetes mellitus em indivíduos com infecção VIH sob terapêutica anti-retroviral e terapêutica anti-diabética oral
Palavras-chave:
Insulinoresistência, terapêutica anti-diabética, terapêutica anti-retroviralResumo
O tratamento da infecção VIH com terapêutica anti-retroviral de
alta eficácia (HAART) pode induzir complicações metabólicas
graves, inclusive insulinoresistência, potencialmente associadas
a um aumento da incidência de doenças cardiovasculares. Tanto
os inibidores da protease (IP) como, em menor extensão, os análogos nucleósidos da transcriptase reversa (INTRs) parecem estar
implicados, por efeitos metabólicos directos dos IP e um efeito indirecto dos IP e dos INTRs. Estas definições, síndrome metabólica
e insulinoresistência, existem para identificar aqueles “em risco” e,
embora o tratamento seja comummente recomendado, o início de
terapêutica anti-diabética será de maior benefício em indivíduos
com maior risco cardiovascular e menor risco de progressão de
VIH. As estratégias mais eficazes no tratamento da diabetes em
doentes sob HAART parecem ser a substituição do IP e/ou o início
de terapêutica anti-diabética com metformina ou tioglitazonas; no
entanto, todos os anti-diabéticos orais têm o seu papel neste tipo
de doentes e não parecem existir interacções entre os diferentes
fármacos hipoglicemiantes e os anti-retrovirais.
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Referências
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