Since the availability of protease inhibitors in 1997, there has been a gre
at change in antiretroviral therapy but also new long term side effects hav
e emerged, mainly metabolic changes such as hypertriglyceridemia, hyperchol
esterinemia and hyperglycemia. Besides, fat redistribution has been observe
d. Fat wastes in the face and limbs but accumulates in the adipose tissue o
f the dorsocervical and abdominal region and the breasts. The mechanism of
these changes remains unclear. For therapy a protease inhibitor free therap
y or lipid lowering drugs may be tried. 29 of our 224 patients developed li
podystrophy. 27 of these patients had been treated with a protease inhibito
r (17 patients with indinavir); 2 of the patients had never received protea
se inhibitors.