A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors.
OBJECTIVE
To describe a syndrome of peripheral lipodystrophy (fat wasting of the face, limbs and upper trunk), hyperlipidaemia and insulin resistance in patients receiving potent HIV protease inhibitor therapy.


METHODS
Cross-sectional study.


METHODS
Outpatient clinic of a university teaching hospital.


METHODS
HIV-infected patients either receiving at least one protease inhibitor (n=116) or protease inhibitor-naive (n=32), and healthy men (n=47).


METHODS
Lipodystrophy was assessed by physical examination and questionnaire and body composition by dual-energy X-ray absorptiometry. Fasting triglyceride, cholesterol, free fatty acid, glucose, insulin, C-peptide and fructosamine levels, other metabolic parameters, CD4 lymphocyte counts, and HIV RNA load were also assessed.


RESULTS
HIV protease inhibitor-naive patients had similar body composition to healthy men. HIV protease inhibitor therapy was associated with substantially lower total body fat (13.2 versus 18.7 kg in protease inhibitor-naive patients; P=0.005), and significantly higher total cholesterol and triglyceride levels. Lipodystrophy was observed clinically in 74 (64%) protease inhibitor recipients after a mean 13.9 months and 1(3%) protease inhibitor-naive patient (P=0.0001). Fat loss occurred in all regions except the abdomen after a median 10 months. Patients with lipodystrophy experienced a relative weight loss of 0.5 kg per month and had significantly higher triglyceride, cholesterol, insulin and C-peptide levels and were more insulin-resistant than protease inhibitor recipients without lipodystrophy. Patients receiving ritonavir and saquinavir in combination had significantly lower body fat, higher lipids and shorter time to lipodystrophy than patients receiving indinavir. Three (2%) patients developed new or worsening diabetes mellitus.


CONCLUSIONS
A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance is a common complication of HIV protease inhibitors. Diabetes mellitus is relatively uncommon.
Carr
A
A
HIV Medicine Unit and Centre for Immunology, St Vincent's Hospital, Sydney, Australia.
Samaras
K
K
Burton
S
S
Law
M
M
Freund
J
J
Chisholm
D J
DJ
Cooper
D A
DA
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001823:Body Composition; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000139:chemically induced; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced* / Q000150:complications; D019469:Indinavir / Q000009:adverse effects / Q000627:therapeutic use; D007333:Insulin Resistance; D008060:Lipodystrophy / Q000139:chemically induced* / Q000150:complications; D008297:Male; D019888:Nelfinavir / Q000009:adverse effects / Q000627:therapeutic use; D012307:Risk Factors; D019438:Ritonavir / Q000009:adverse effects / Q000627:therapeutic use; D019258:Saquinavir / Q000009:adverse effects / Q000627:therapeutic use; D013577:Syndrome
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D019469:Indinavir; D019888:Nelfinavir; D019258:Saquinavir; D019438:Ritonavir