Evaluation of glucose uptake by skeletal muscle tissue and subcutaneous fat in HIV-infected patients with and without lipodystrophy using FDG-PET

Abstract

Objective: To evaluate differences in glucose uptake by skeletal muscle tissue and subcutaneous fat in HIV patients on HAART (highly active antiretroviral therapy) presenting with and without lipodystrophy as well as in drug-naïve HIV patients using FDG PET. Patients and methods:Thirty-nine consecutive patients suffering from HIV, respectively 7 drug-naïve patients, 21 non-lipodystrophic patients on HAART and 11 patients on HAART, suffering from lipodystrophy were prospectively included. All patients underwent a wholebody FDG PET examination. Standardized uptake values (SUV values) of muscle and subcutaneous fat were compared and related to demographic and biochemical variables.Results: SUVmean values of subcutaneous fat were significantly higher in patients under HAART presenting with lipodystrophy when compared to untreated on treated, nonlipodystrophic, patients (p=0.000). SUVmean values of subcutaneous fat significantly correlated with treatment duration (r=0.56, p=0.000) and CD4 count (r= 0.51, p=0.001) and inversely correlated with viral load (r=-0.61, p= 0.000). Finally, SUV mean values of thigh muscles were not significantly different between the 3 different patient groups under study. Conclusion:Quantitative FDG uptake by subcutaneous fat proved significantly higher in HIV patients under HAART presenting with lipodystrophy. HAART did not influence FDG uptake by human skeletal muscle tissue under basal conditions.

FDG-PET Imaging in HIV Infection and Tuberculosis

“…5). 108 Without the knowledge of this phenomenon, this uptake pattern may be misinterpreted as diffuse soft tissue inflammation, or even as a technical fault with attenuation correction. The potential role of FDG-PET in monitoring response to various treatment options aimed at reducing insulin resistance in lipodystrophic HIV patients under HAART warrants further investigation.…”

The concomitant use of second-generation antipsychotics and long-term antiretroviral therapy may be associated with increased cardiovascular risk

“…quetiapine), leading to higher plasma antipsychotic levels and potentially more pronounced adverse effects (Singh and Goodkin, 2007; Thompson et al, 2006; Tseng and Foisy, 1999); however this pharmacokinetic interaction between ART and SGAs is not confirmed by literature that doesn’t correlate plasma level of SGAs to metabolic side effects (Coe and Hong, 2012; Suzuki et al, 2011). Both drug classes may decrease activity of the glucose transporter 4 in the myocyte cell membrane, leading to decreased glucose uptake, insulin resistance and hyperinsulinemia (Sathekge et al, 2010). Increased production of cytokines (Lihn et al, 2003; Pacenti et al, 2006) and mitochondrial toxicity in adipose tissue, both well-known side effects of ARTs, could induce adipocyte apoptosis (Buffet et al, 2005).…”

White fat, factitious hyperglycemia, and the role of FDG PET to enhance understanding of adipocyte metabolism

“…FGF-21 has been shown to stimulate glucose uptake in adipocytes and suppress hepatic glucose production [23]. Elevated FGF-21 levels have also been described in patients with HIV-associated lipodystrophy [24], where atypical FDG fat distribution is also described [25,26]. …”