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"All
of these factors contribute to the difficulty of interpreting the enormous
amount of information on CLA."
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HIV patients receiving
anti-retroviral therapy (ART) may exhibit metabolic changes related to
lipid metabolism such as elevated serum cholesterol and triglycerides (5-9)
or a gain of visceral and loss of subcutaneous fat commonly termed lipodystrophy.
Further, elevated glucose, insulin resistance and diabetes mellitus are
extensively reported in subjects treated with protease inhibitor (PI)-based
antiretroviral regimens. (10-15)
Osteopenia, osteoporosis,
and osteonecrosis are the most significant bone disorders affecting HIV-infected
persons. A high prevalence of HIV-infected patients receiving ART exhibit
reduced bone mineral density (BMD). However, persons living with HIV and
not receiving antiretrovirals also have a higher than expected prevalence
of reduced BMD, which suggests that HIV itself may be a contributing factor,
mediated by immune activation and cytokines. The risk of fractures remains
undefined in this population, and no data exist on interventions to increase
BMD and prevent fractures. (16-19)
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Numerous
physiological properties have been attributed to CLA including action as
an anti-adipogenic (fat), anti-diabetogenic (insulin), anti-carcinogenic
(cancer) and anti-atherosclerotic (cardiovascular) agent. (20) In addition,
CLA has effects on bone formation and the immune system as well as fatty
acid and lipid metabolism and gene expression in numerous tissues. (2,
21-24) Still, it is not clear exactly how CLA produces its numerous
metabolic effects. While exciting potential exists for CLA supplementation
to serve as a useful supplement in AIDS, clinical research has been limited.
This article will examine
the evidence for the potential efficacy of CLA supplementation in HIV-associated
hyperlipidemia, lipodystrophy, and diabetes. Because the amount of
information covered by this topic is large, this review has been divided
into two sections. Part I will evaluate the in vitro and animal data on
CLA and part II will describe the published CLA clinical intervention studies.
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