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HIV, HIV treatment and changes in your metabolism
Metabolism refers to the way that our bodies process all the things that cells need in order to work properly. If metabolism is abnormal, this means that some of these processes are out of balance.
Metabolism – the basics
The general term for blood fats is lipids. There are two main types of lipids: cholesterol and triglycerides.
Cholesterol
Cholesterol comes in two main sorts – ‘good’ and ‘bad’.
- Good cholesterol is called HDL. It is a measure of protection against heart disease and is often reduced in people with HIV and other chronic illnesses. Levels of HDL cholesterol may rise after starting combination therapy.
- Bad cholesterol is called LDL. A high level of LDL cholesterol and a low level of HDL cholesterol increase your risk of heart disease. Anti-HIV therapy – and lipodystrophy – have been associated with high LDL and high total cholesterol levels. Rises in LDL levels may occur after starting therapy, particularly
with combinations including several of the PIs.
If you have high LDL cholesterol levels, certain risk factors increase your risk of heart disease further:
- Smoking.
- High blood pressure.
- A family history of heart disease.
- Physical inactivity.
- Age over 45 years if male or 55 years if female.
- Diabetes mellitus or insulin resistance.
- High triglycerides.
- Lack of regular exercise.
- Obesity, especially central fat accumulation.
- Use of cocaine or amphetamines.
For people on most protease inhibitors, it is especially important to monitor levels of ‘bad’ cholesterol (LDL).
Triglycerides
Triglycerides are fatty acids derived from fat, sugar and starches in food, and from excess alcohol, which travel through the bloodstream to be stored in tissues or the liver.
Glucose
Glucose is the form of sugar found in the blood. High levels of glucose may increase the risk of heart disease.
Insulin
Insulin is the substance produced in order to control glucose levels in the blood. Some people on combination therapy need to produce more insulin to keep their blood
levels of glucose normal. This is called insulin resistance. It may also be necessary to test insulin levels in some individuals.
How will I know if I have metabolic changes?
Abnormalities in sugar and fat levels and in the processing of fats and sugars can occasionally cause physical symptoms
such as:
- Tiredness.
- Dizziness (due to high blood pressure).
- Loss of concentration.
- More frequent urination.
- Feeling thirsty most of the time.
However, many people do not notice any problems for a long time even when they have levels of fats and/or sugar in the blood that put them at risk of heart disease in the future.
see PDf for table - How do I know if my blood test results are normal?
Cholesterol levels can vary from day to day so you should not place too much emphasis on a single high measurement. It’s the trend over time that is important. The same goes for other measurements discussed in this section. The main influence over cholesterol levels is genetic whereas diet choices are particularly important for managing triglycerides and may help glucose and insulin levels. Measuring fasted levels is
the most accurate way to assess lipids and glucose.