{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:50:38Z","timestamp":1790812238057,"version":"4.1.0"},"reference-count":124,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2009,1,1]],"date-time":"2009-01-01T00:00:00Z","timestamp":1230768000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxicol Pathol"],"published-print":{"date-parts":[[2009,1]]},"abstract":"<jats:p>Metabolic complications associated with HIV infection and treatment frequently present as a relative lack of peripheral adipose tissue associated with dyslipidemia and insulin resistance. In this review we explain the connection between abnormalities of intermediary metabolism, observed either in vitro or in vivo, and this group of metabolic effects. We review molecular mechanisms by which the HIV protease inhibitor (PI) class of drugs may affect the normal stimulatory effect of insulin on glucose and fat storage. We then propose that both chronic inflammation from HIV infection and treatment with some drugs in this class trigger cellular homeostatic stress responses with adverse effects on intermediary metabolism. The physiologic outcome is such that total adipocyte storage capacity is decreased, and the remaining adipocytes resist further fat storage. The excess circulating and dietary lipid metabolites, normally \u201cabsorbed\u201d by adipose tissue, are deposited ectopically in lean (muscle and liver) tissue, where they impair insulin action. This process leads to a pathologic cycle of lipotoxicity and lipoatrophy and a clinical phenotype of body fat distribution with elevated waist-to-hip ratio similar to the metabolic syndrome.<\/jats:p>","DOI":"10.1177\/0192623308327119","type":"journal-article","created":{"date-parts":[[2009,1,26]],"date-time":"2009-01-26T20:54:49Z","timestamp":1233003289000},"page":"65-77","source":"Crossref","is-referenced-by-count":79,"title":["The Role of Protease Inhibitors in the Pathogenesis of HIV-Associated Lipodystrophy: Cellular Mechanisms and Clinical Implications"],"prefix":"10.1177","volume":"37","author":[{"given":"Oliver P.","family":"Flint","sequence":"first","affiliation":[{"name":"Pharmaceutical Research and Development, Bristol-Myers\rSquibb Company, Princeton, New Jersey, oliver.flint@bms.com"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa A.","family":"Noor","sequence":"additional","affiliation":[{"name":"GlaxoSmithKline, King of Prussia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Hruz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Washington University School\rof Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil B.","family":"Hylemon","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Virginia\rCommonwealth University, Richmond, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Yarasheski","sequence":"additional","affiliation":[{"name":"Department of Medicine, Washington University School\rof Medicine, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald P.","family":"Kotler","sequence":"additional","affiliation":[{"name":"Department of Medicine, St. Luke's-Roosevelt Hospital\rCenter, Columbia University College of Physicians and Surgeons, New York,\rNew York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rex A.","family":"Parker","sequence":"additional","affiliation":[{"name":"Pharmaceutical Research and Development, Bristol-Myers\rSquibb Company, Princeton, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aouatef","family":"Bellamine","sequence":"additional","affiliation":[{"name":"Pharmaceutical Research and Development, Bristol-Myers\rSquibb Company, Princeton, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2009,1,1]]},"reference":[{"key":"atypb1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1293.2005.00320.x"},{"key":"atypb2","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000182230.47819.aa"},{"key":"atypb3","doi-asserted-by":"publisher","DOI":"10.2174\/138161207781039661"},{"key":"atypb4","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199907090-00001"},{"key":"atypb5","doi-asserted-by":"publisher","DOI":"10.1038\/90992"},{"key":"atypb6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)06102-4"},{"key":"atypb7","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.165.10.1179"},{"key":"atypb8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2004.09.027"},{"key":"atypb9","doi-asserted-by":"publisher","DOI":"10.1194\/jlr.M200245-JLR200"},{"key":"atypb10","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.50.6.1378"},{"key":"atypb11","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200311210-00005"},{"key":"atypb12","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200411050-00004"},{"key":"atypb13","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199807000-00003"},{"key":"atypb14","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.0000146672.10582.17"},{"key":"atypb15","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0704212104"},{"key":"atypb16","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.106.111849"},{"key":"atypb17","doi-asserted-by":"publisher","DOI":"10.1096\/fasebj.6.7.1563593"},{"key":"atypb18","doi-asserted-by":"publisher","DOI":"10.1086\/498525"},{"key":"atypb19","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)63513-1"},{"key":"atypb20","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1086\/378131","volume":"37","year":"2003","journal-title":"Clin Infect Dis"},{"key":"atypb21","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000183629.20041.bb"},{"key":"atypb22","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-004-1347-1"},{"key":"atypb23","doi-asserted-by":"publisher","DOI":"10.1007\/s00210-004-0933-6"},{"key":"atypb24","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2006.02.024"},{"key":"atypb25","doi-asserted-by":"publisher","DOI":"10.1177\/039463200702000310"},{"key":"atypb26","first-page":"1423","volume":"76","year":"1993","journal-title":"J Clin Endocrinol Metab"},{"key":"atypb27","doi-asserted-by":"publisher","DOI":"10.1016\/0887-2333(94)90042-6"},{"key":"atypb28","first-page":"L32","volume":"10","year":"2005","journal-title":"Antivir Ther"},{"key":"atypb29","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200305230-00010"},{"key":"atypb30","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa062744"},{"issue":"2","key":"atypb31","first-page":"23S","volume":"118","year":"2005","journal-title":"Am J Med"},{"key":"atypb32","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000111245.75752.C6"},{"key":"atypb33","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1007389"},{"key":"atypb34","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(91)80154-E"},{"issue":"2","key":"atypb35","first-page":"S43","volume":"37","year":"2003","journal-title":"Clin Infect Dis"},{"key":"atypb36","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00273.2005"},{"key":"atypb37","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200404090-00016"},{"key":"atypb38","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1326.2005.00546.x"},{"key":"atypb39","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.54.12.3474"},{"key":"atypb40","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/135.1.53"},{"key":"atypb41","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/31.5.1016"},{"key":"atypb42","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M410826200"},{"key":"atypb43","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M105200200"},{"key":"atypb44","doi-asserted-by":"publisher","DOI":"10.1042\/cs0800359"},{"key":"atypb45","doi-asserted-by":"publisher","DOI":"10.1016\/0026-0495(91)90059-6"},{"key":"atypb46","doi-asserted-by":"publisher","DOI":"10.1172\/JCI0215593"},{"key":"atypb47","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.51.4.937"},{"key":"atypb48","doi-asserted-by":"publisher","DOI":"10.1086\/430379"},{"key":"atypb49","doi-asserted-by":"publisher","DOI":"10.1086\/498505"},{"key":"atypb50","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199911120-00019"},{"key":"atypb51","doi-asserted-by":"publisher","DOI":"10.1086\/521935"},{"key":"atypb52","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6300(1999)11:2<225::AID-AJHB10>3.0.CO;2-J"},{"key":"atypb53","doi-asserted-by":"publisher","DOI":"10.1038\/nrm829"},{"key":"atypb54","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.52.7.1695"},{"key":"atypb55","doi-asserted-by":"publisher","DOI":"10.1016\/S1262-3636(07)70121-0"},{"key":"atypb56","doi-asserted-by":"publisher","DOI":"10.1021\/bi035596s"},{"key":"atypb57","first-page":"L6","volume":"9","year":"2004","journal-title":"Antiviral Therapy"},{"key":"atypb58","doi-asserted-by":"publisher","DOI":"10.1007\/s11908-004-0067-5"},{"key":"atypb59","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200403050-00008"},{"key":"atypb60","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-996-0008-z"},{"key":"atypb61","first-page":"L11","volume":"10","year":"2005","journal-title":"Antivir Ther"},{"key":"atypb62","doi-asserted-by":"publisher","DOI":"10.1086\/505974"},{"key":"atypb63","doi-asserted-by":"publisher","DOI":"10.1038\/nm1201-1327"},{"key":"atypb64","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygeno.2007.06.004"},{"key":"atypb65","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00039-07"},{"key":"atypb66","doi-asserted-by":"publisher","DOI":"10.1016\/j.mito.2004.06.009"},{"key":"atypb67","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200007070-00002"},{"key":"atypb68","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200305020-00005"},{"key":"atypb69","first-page":"3","volume":"9","year":"2007","journal-title":"AIDS Rev"},{"key":"atypb70","doi-asserted-by":"publisher","DOI":"10.1086\/380790"},{"key":"atypb71","doi-asserted-by":"publisher","DOI":"10.1046\/j.1468-1293.2003.00159.x"},{"key":"atypb72","doi-asserted-by":"publisher","DOI":"10.1097\/00042560-199705010-00007"},{"key":"atypb73","doi-asserted-by":"publisher","DOI":"10.1097\/00042560-200001010-00005"},{"key":"atypb74","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000214811.72916.67"},{"key":"atypb75","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.C000228200"},{"key":"atypb76","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200204120-00005"},{"key":"atypb77","doi-asserted-by":"publisher","DOI":"10.1210\/me.2003-0388"},{"key":"atypb78","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.50.6.1397"},{"key":"atypb79","volume-title":"11th Conferece on Retroviruses and Opportunistic Infections"},{"key":"atypb80","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000244200.11006.55"},{"key":"atypb81","first-page":"F11","volume":"15","year":"2001","journal-title":"AIDS"},{"key":"atypb82","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200411050-00005"},{"key":"atypb83","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200203290-00002"},{"key":"atypb84","first-page":"5230","volume":"62","year":"2002","journal-title":"Cancer Res"},{"key":"atypb85","doi-asserted-by":"publisher","DOI":"10.1124\/mol.104.010165"},{"key":"atypb86","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbabio.2006.05.001"},{"key":"atypb87","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00625-06"},{"key":"atypb88","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200001070-00006"},{"key":"atypb89","doi-asserted-by":"publisher","DOI":"10.2337\/db06-0255"},{"key":"atypb90","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00236.2005"},{"key":"atypb91","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M104557200"},{"key":"atypb92","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.22.2978"},{"key":"atypb93","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200201040-00003"},{"key":"atypb94","doi-asserted-by":"publisher","DOI":"10.1038\/nrm2199"},{"key":"atypb95","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-201X.2004.01383.x"},{"key":"atypb96","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199912240-00002"},{"key":"atypb97","doi-asserted-by":"crossref","first-page":"113","DOI":"10.2337\/dc06-1075","volume":"30","year":"2007","journal-title":"Diabetes Care"},{"key":"atypb98","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.274.50.35734"},{"key":"atypb99","doi-asserted-by":"publisher","DOI":"10.1007\/s001250051505"},{"key":"atypb100","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/81.6.1405"},{"key":"atypb101","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-1273"},{"key":"atypb102","doi-asserted-by":"publisher","DOI":"10.2174\/1568005054880163"},{"key":"atypb103","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000143599.64234.15"},{"key":"atypb104","doi-asserted-by":"publisher","DOI":"10.1038\/oby.2003.48"},{"key":"atypb105","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.53.5.1215"},{"key":"atypb106","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.54.3.591"},{"key":"atypb107","doi-asserted-by":"publisher","DOI":"10.1016\/S0092-8674(00)80835-1"},{"key":"atypb108","doi-asserted-by":"publisher","DOI":"10.1210\/en.2003-0870"},{"key":"atypb109","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200111090-00004"},{"key":"atypb110","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200307040-00011"},{"key":"atypb111","doi-asserted-by":"publisher","DOI":"10.1016\/j.tips.2004.12.005"},{"key":"atypb112","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199815000-00001"},{"key":"atypb113","first-page":"L5","volume":"10","year":"2005","journal-title":"Antivir Ther"},{"key":"atypb114","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3282efad32"},{"key":"atypb115","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-1241.2007.01385.x"},{"key":"atypb116","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.86.5.7463"},{"key":"atypb117","doi-asserted-by":"publisher","DOI":"10.1016\/j.bcp.2003.08.044"},{"key":"atypb118","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.52.4.918"},{"key":"atypb119","doi-asserted-by":"publisher","DOI":"10.1086\/507333"},{"key":"atypb120","doi-asserted-by":"publisher","DOI":"10.1210\/en.2003-1140"},{"key":"atypb121","doi-asserted-by":"publisher","DOI":"10.1172\/JCI26373"},{"key":"atypb122","doi-asserted-by":"publisher","DOI":"10.1097\/01.qai.0000176654.97392.c7"},{"key":"atypb123","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.R400008200"},{"key":"atypb124","first-page":"251","volume":"35","year":"2006","journal-title":"Zhejiang da xue xue bao. Yi xue ban (Journal of Zhejiang University)"}],"container-title":["Toxicologic Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0192623308327119","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0192623308327119","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T16:30:25Z","timestamp":1777653025000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0192623308327119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,1]]},"references-count":124,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2009,1]]}},"alternative-id":["10.1177\/0192623308327119"],"URL":"https:\/\/doi.org\/10.1177\/0192623308327119","relation":{},"ISSN":["0192-6233","1533-1601"],"issn-type":[{"value":"0192-6233","type":"print"},{"value":"1533-1601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,1]]}}}