A SYNDROME OF PERIPHERAL LIPODYSTROPHY, HYPERLIPIDEMIA AND INSULIN-RESISTANCE IN PATIENTS RECEIVING HIV PROTEASE INHIBITORS

Objective: To describe a syndrome of peripheral lipodystrophy (fat was ting of the face, limbs and upper trunk), hyperlipidaemia and insulin resistance in patients receiving potent HIV protease inhibitor therapy . Design: Cross-sectional study. Setting: Outpatient clinic of a unive rsity teaching hospital. Patients: HIV-infected patients either receiv ing at least one protease inhibitor (n = 116) or protease inhibitor-na ive (n = 32), and healthy men (n = 47). Interventions and main outcome measures: Lipodystrophy was assessed by physical examination and ques tionnaire and body composition by dual-energy X-ray absorptiometry. Fa sting triglyceride, cholesterol, free fatty acid, glucose, insulin, C- peptide and fructosamine levels, other metabolic parameters, CD4 lymph ocyte counts, and HIV RNA load were also assessed. Results: HIV protea se inhibitor-naive patients had similar body composition to healthy me n. HIV protease inhibitor therapy was associated with substantially lo wer total body fat (13.2 versus 18.7 kg in protease inhibitor-naive pa tients; P = 0.005), and significantly higher total cholesterol and tri glyceride levels. Lipodystrophy was observed clinically in 74 (64%) pr otease inhibitor recipients after a mean 13.9 months and 1 (3%) protea se inhibitor-naive patient (P = 0.0001). Fat loss occurred in all regi ons except the abdomen after a median 10 months. Patients with lipodys trophy 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 recipie nts without lipodystrophy. Patients receiving ritonavir and saquinavir in combination had significantly lower body fat, higher lipids and sh orter time to lipodystrophy than patients receiving indinavir. Three ( 2%) patients developed new or worsening diabetes mellitus. Conclusion: A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin r esistance is a common complication of HIV protease inhibitors. Diabete s mellitus is relatively uncommon. (C) 1998 Lippincott-Raven Publisher s.