Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy

We evaluated metabolic and clinical features of 71 HIV-infected patients wi th lipodystrophy by comparing them with 213 healthy control subjects, match ed for age and body mass index, from the Framingham Offspring Study. Thirty HIV-infected patients without fat redistribution were compared separately with 90 matched control subjects from the Framingham Offspring Study. Fasti ng glucose, insulin, and lipid levels; glucose and insulin response to stan dard oral glucose challenge; and anthropometric measurements were determine d. HIV-infected patients with lipodystrophy demonstrated significantly incr eased waist-to-hip ratios, fasting insulin levels, and diastolic blood pres sure compared with controls. Patients with lipodystrophy were more likely t o have impaired glucose tolerance, diabetes, hypertriglyceridemia, and redu ced levels of high-density lipoprotein (HDL) cholesterol than were controls . With the exception of HDL cholesterol level, these risk factors for cardi ovascular disease (CVD) were markedly attenuated in patients without lipody strophy and were not significantly different in comparison with controls. T hese data demonstrate a metabolic syndrome characterized by profound insuli n resistance and hyperlipidemia. CVD risk factors are markedly elevated in HIV-infected patients with fat redistribution.