Diabetes, insulin resistance and dyslipidaemia in lipodystrophic HIV-infected patients on highly active antiretroviral therapy (HAART)

This study assessed glucose tolerance, insulin sensitivity and lipid parame ters in HIV-infected patients presenting with lipodystrophy during HAART in cluding protease inhibitors. Fourteen consecutive patients from Rothschild Hospital treated with HAART and presenting with marked facial lipoatrophy w ere evaluated. A 75 g oral glucose tolerance test (OGTT) with measurement o f plasma glucose, insulin, proinsulin and free fatty acids at T0, 30, 60, 9 0 and 120 min was performed. Lipid parameters (triglycerides, cholesterol, apolipoproteins A1 and B) were studied as well as nutritional and inflammat ory markers (albumin, prealbumin, transferrin, haptoglobin, orosomucoid, C- reactive protein), endocrine and cytokine parameters (thyrotropin, cortisol , leptin, interleukin-6), HIV viral load and CD4-lymphocyte count These pat ients were compared with 20 non-lipodystrophic protease inhibitor-treated p atients. The measurements performed during OGTT showed that among the 14 li podystrophic patients, 11 (79 %) presented with diabetes (5 patients) or no rmal glucose tolerance but with insulin resistance (6 patients). This frequ ency was strikingly different in the group of non-lipodystrophic patients, which included only 4 (20 %) presenting with diabetes (1 patient), or impai red glucose tolerance (2 patients), or normal glucose tolerance but with in sulin resistance (1 patient). Hypertriglyceridaemia was present in 11 lipod ystrophic (79 %) versus 7 non-lipodystrophic patients (35 %). Nutritional a nd endocrine measurements were normal. An abnormal processing of proinsulin to insulin was excluded. Thus, lipodystrophy during HAART was associated w ith diabetes, insulin resistance and hypertriglyceridaemia. Diabetes, diagn osed by basal and/or 120 min-OGTT glycaemia, seems more frequent than previ ously described. The therapeutic consequences of these results deserve eval uation in clinical trials.