Clinical lipoatrophy in HIV-1 patients on HAART is not associated with increased abdominal girth, hyperlipidaemia or glucose intolerance.
OBJECTIVE
To compare information on body fat changes from questionnaire and clinical examination and to study lipoatrophy in HIV-1 patients on highly active antiretroviral therapy (HAART).


METHODS
The study was cross-sectional within a randomized trial. One hundred and sixty-eight male HIV-1 patients were examined by questionnaire and clinical examination. Clinical lipoatrophy was studied and defined as fat wasting in the face, legs and/or arms. Fasting blood samples reflecting lipid and glucose metabolism were taken and the role of indinavir, ritonavir (RTV) and RTV/saquinavir (SQV) on lipoatrophy was investigated.


RESULTS
After a median of 17 months on HAART, concordance rates between information on changes in body fat from questionnaire and clinical examination were significant and varied from 70 to 96%. With a positive criteria of lipoatrophy in both assessments, 14% of patients had lipoatrophy. These patients had lower weight (P = 0.0007), weight loss from baseline (P = 0.003), lower circumferences at all measurements (P < 0.01), lower plasma triglycerides and low-density lipoprotein (LDL) (P < 0.05) and longer treatment with stavudine (P = 0.0009). Homeostasis model assessment (HOMA) estimates for insulin resistance and beta-cell function were comparable. Plasma cholesterol, triglycerides and very low-density lipoprotein (VLDL) were higher in patients receiving RTV or RTV/SQV (P < 0.03).


CONCLUSIONS
Questionnaire and clinical assessment provide concordant information on changes in body fat. Lipoatrophic patients on HAART with neither increase in abdominal circumference, nor hyperlipidaemia nor glucose intolerance may have side-effects to protease inhibitor treatment, to nucleoside reverse transcriptase inhibitor treatment (stavudine) or suffer from a drug-independent condition.
Worm
D
D
Department of Medical Physiology, The Panum Institute, University of Copenhagen, Copenhagen, Denmark. dworm@mfi.ku.dk
Kirk
O
O
Andersen
O
O
Vinten
J
J
Gerstoft
J
J
Katzenstein
T L
TL
Nielsen
H
H
Pedersen
C
C
D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D001823:Body Composition; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D018149:Glucose Intolerance / Q000139:chemically induced; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019247:HIV Wasting Syndrome / Q000139:chemically induced; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced; D019469:Indinavir / Q000008:administration & dosage / Q000009:adverse effects*; D008060:Lipodystrophy / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D019438:Ritonavir / Q000008:administration & dosage / Q000009:adverse effects*; D019258:Saquinavir / Q000008:administration & dosage / Q000009:adverse effects*; D018119:Stavudine / Q000009:adverse effects; D011795:Surveys and Questionnaires
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D019469:Indinavir; D018119:Stavudine; D019258:Saquinavir; D019438:Ritonavir