By Giuseppe Barbaro, Franck Boccara, Paul Skolnik, Giorgio Barbarini
This e-book makes a speciality of a few of the new medical and organic insights concerning HIV-associated metabolic and cardiovascular problems within the HAART period. The advent of hugely energetic antiretroviral treatment (HAART) has altered cardiovascular manifestations in HIV. at the one hand, HAART has considerably more desirable the standard of lifetime of HIV-infected sufferers. nevertheless, the early facts have raised a few matters, growing an fascinating medical surroundings.
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Extra info for Cardiovascular Disease in AIDS, 2nd Edition
Example text
Ao, aorta; LV, left ventricle Fig. 9 Large anterior mitral vegetation in an HIV- Fig. 11 Significant mitral regurgitation in HIV- infected patient, detected by transesophageal echocardiography. Ao, aorta; LA, left atrium; LV, left ventricle infected patients with endocarditis, detected by color Doppler trans-thoracic echocardiography (parasternal long-axis view). RV, right ventricle; LV, left ventricle; Ao, aorta; LA, left atrium Endocardial Involvement Chapter 2 • Evolution and Pathogenesis of the Involvement of the Cardiovascular System in HIV Infection from infective endocarditis of about 30% higher than do asymptomatic HIV-infected patients [41].
The activation of the two adiponectin receptors leads to the activation of the transcription factor PPARα and AMPK in the liver and muscles [16]. There has been a major interest in the role of this enzyme in cell metabolism. AMPK is activated by AMP, the level of which is increased when ATP has been hydrolyzed. AMPK now appears as an energy level-detecting enzyme, which plays a key role in redirecting the energy-synthesizing pathways of glucose and lipid metabolism. First, activated AMPK is able to indirectly activate the entry of acyl-CoA into the mitochondria to be degraded by the β-oxidation pathway in the liver and muscles and to be converted into energy.
In that situation, muscle and liver cells use FFA to produce the energy required for their metabolism. In addition to its metabolic function, adipose tissue now appears to play an important endocrine role: it can release a number of hormones, proteins, and cytokines acting through endocrine or autocrine/paracrine mechanisms and collectively called adipokines (Fig. 2) [12–14]. Leptin Leptin is a 16-kDa protein mainly produced by subcutaneous adipose tissue, and it acts as an endocrine factor at the hypothalamic Chapter 3 • Pathogenesis of Antiretroviral Treatment-Associated Metabolic Syndrome Fig.