Lipodystrophy in patients naive to HIV protease inhibitors

Madge, Sara; Kinloch-de-Loes, Sabine; Mercey, D; Johnson, Margaret; Weller, I.V.D.

doi:10.1097/00002030-199904160-00020

Cited by 175 publications

(101 citation statements)

References 7 publications

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“…In the HAART era, several studies have shown higher total cholesterol, LDL-C and triglyceride levels associated with PI use [6][7][8]. However, consistent with other investigators' findings of increased lipid levels even in patients on non-PI regimens, we found that non-PI HAART was associated with elevated levels of atherogenic lipoproteins similar to those seen with PI-based HAART [9,10].…”

Section: Discussionsupporting

confidence: 90%

Increased serum lipids are associated with higher CD4 lymphocyte count in HIV‐infected women

Floris-Moore

Howard

et al. 2006

HIV Medicine

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ObjectiveHighly active antiretroviral therapy (HAART) has been associated with dyslipidaemia; however, the roles of immune status and non-HIV-disease risk factors remain unclear. MethodsA cross-sectional analysis of fasting lipids was carried out for 231 women, of whom 132 were HIVinfected and 99 were uninfected. The concentrations of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, and apolipoprotein B (apo B) were measured. CD4 lymphocyte count, hepatitis C status, demographics, diet, and anthropometrics were also assessed. ResultsA total of 132 women were HIV-infected [30 were antiretroviral-naive, 68 were on protease inhibitors (PIs), and 34 were on non-PI HAART]. HIV infection was associated with higher triglycerides, lower HDL-C, and, among obese women, higher total cholesterol and LDL-C. Non-PI and PI HAART were each independently associated with higher total cholesterol, LDL-C, and apo B, compared with being ART-naive. Among HIV-infected women, after adjustment for HAART use, women with a CD4 lymphocyte count ! 500 cells/mL had total cholesterol 41.8 mg/dL (P 5 0.002) and LDL-C 28.8 mg/dL (P 5 0.01) higher, on average, than women with a CD4 count o200 cells/mL. Women with a CD4 count of 200-499 cells/mL had total cholesterol 26.31 mg/dL higher, on average, than those with a CD4 count o200 cells/mL (P 5 0.04), although differences in LDL-C did not reach significance (15.51 mg/dL; P 5 0.12). A higher CD4 count was also associated with higher apo B (Po0.001). Active hepatitis C infection was associated with lower total cholesterol, LDL-C, triglycerides, and apo B. ConclusionsHigher CD4 lymphocyte counts were associated with higher lipid levels, suggesting that immune competence may independently affect the dyslipidaemia seen in the HAART era. In addition, it is important that hepatitis C status be assessed in studies of dyslipidaemia in the HIV-infected population.Keywords: antiretroviral therapy, drug use, dyslipidaemia, women IntroductionHighly active antiretroviral therapy (HAART) has dramatically increased life expectancy among HIV-infected persons. However, several metabolic complications have been reported in association with HAART, including insulin resistance and dyslipidaemia [1][2][3][4][5]. There have been reports of high total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triglyceride levels associated with protease inhibitor (PI) use [6][7][8]. High total cholesterol and triglyceride levels have also been reported in patients on non-PI HAART regimens [9,10]. In addition, low high-density lipoprotein (HDL-C) levels and hypertriglyceridaemia have been described in HIV-infected patients not receiving antiretroviral therapy [11][12][13]. 421Other factors, including dietary fat intake, physical activity, obesity, and genetics, may influence lipid levels [14][15][16]. Low levels of adiponectin, an adipocyte-derived peptide inversely related to insulin resistance and dyslipidaemia, have been reported in HIV-i...

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Section: Discussionsupporting

confidence: 90%

Increased serum lipids are associated with higher CD4 lymphocyte count in HIV‐infected women

Floris-Moore

Howard

et al. 2006

HIV Medicine

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“…Similar to other congenital forms of lipodystrophies, HIV lipodystrophy has been shown to be associated with dyslipidemia and insulin resistance (1,3,6). These metabolic alterations are probably, at least in part, secondary to fat redistribution but could also result from drug toxicity (4,7) and can be influenced by individual susceptibility; the role of the virus itself has also been suggested (8). Protease inhibitors (PIs) have been reported to favor insulinresistance and hypertriglyceridemia (9), but the prevalence and severity of altered fat distribution are increased in patients treated with both PIs and nucleoside reverse-transcriptase inhibitor (NRTI) (10).…”

mentioning

confidence: 96%

Serum Adiponectin and Leptin Concentrations in HIV-Infected Children with Fat Redistribution Syndrome

Verkauskienė

Dollfus²,

Lévine

et al. 2006

Pediatr Res

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Human immunodeficiency virus (HIV)-related lipodystrophy is characterized by adipose tissue redistribution, dyslipidemia, and insulin resistance. We hypothesized that fat redistribution and metabolic abnormalities in HIV-infected children are related to alterations in endocrine function of adipose tissue. A multicenter study was conducted in 130 HIV-infected children. Lipodystrophy definition was based on the central to peripheral skinfold ratio. Fasting adiponectin, leptin, insulin concentrations, glycemia, and lipid profile were measured in all children. Fat redistribution syndrome was apparent in 32 children: 14 with atrophic (LPDA) and 18 with hypertrophic lipodystrophy (LPDH). Mean serum adiponectin levels were significantly decreased in LPDA and LPDH groups compared with the group with no lipodystrophy (LPDϪ). Fasting insulin concentration was significantly higher in LPDA and LPDH groups versus LPDϪ. Mean serum leptin concentration was significantly increased only in LPDH compared with LPDA and LPDϪ groups. Triglyceride levels were significantly increased and highdensity lipoprotein (HDL)-cholesterol concentration decreased in the LPDA versus LPDϪ group. Controlling for puberty stage, gender, percentage of total fat mass, serum lipids, HIV treatment, and disease severity, adiponectin was significantly and inversely associated with central obesity and insulin/glucose ratio. Fat redistribution had no significant effect on leptin concentration, which was directly related to the percentage of body fat, female gender, and insulin/glucose ratio. In conclusion, HIV-infected children with symptoms of fat redistribution have decreased levels of adiponectin, associated with insulin resistance and dyslipidemia.

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“…Após cinco anos de seguimento de pacientes HIV positivos, em terapia com IP verificou-se uma incidência cumulativa de 20% de casos de hipercolesterolemia e hipertrigliceridemia. Outro estudo 19 demonstrou que um grupo de pacientes que nunca recebeu IP, e que estava em tratamento com inibidores de transcriptase reversa análogos de nucleosídeo, apresentou níveis elevados de triglicerídeos, sugerindo a existência de outros fatores 11 .…”

Section: Alterações Dos Lipídeosunclassified

Abordagem metabólica e nutricional da lipodistrofia em uso da terapia anti-retroviral

Dutra

Libonati

2008

Rev. Nutr.

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A terapia anti-retroviral altamente ativa, usada contra o Vírus da Imunodeficiência Humana, vem possibilitando a melhora do quadro clínico-laboratorial de portadores da Síndrome da Imunodeficiência Adquirida. Contudo, alterações metabólicas e complicações morfológicas, associadas ao uso da terapia, vêm sendo investigadas. A utilização prolongada desta terapia tem um impacto importante sobre o estado nutricional dos pacientes. Antes da sua utilização, a perda de peso e a desnutrição, conseqüências das infecções oportunistas, eram os maiores problemas nutricionais. Atualmente, o foco principal das discussões têm sido as complicações metabólicas e morfológicas, dentre elas a lipodistrofia, com a dislipidemia, a resistência à insulina, a osteopenia, e a distribuição alterada da gordura corporal, aumentando assim os riscos de doenças cardiovasculares. A nutrição desempenha um papel fundamental no suporte da saúde desses pacientes, integrando as equipes multiprofissionais, promovendo a melhora da adesão à terapia anti-retroviral e do prognóstico da doença. No entanto, para que se tenha mais conhecimento sobre a terapia, as proporções de seus efeitos adversos, e o perfil nutricional desses pacientes, a curto e a longo prazos, é de suma importância que se estude mais sobre este assunto, a fim de permitir perspectivas de um regime terapêutico mais seguro dentro de seus alcances metodológicos, proporcionando uma melhor qualidade de vida aos pacientes. Termos de indexação:Lipodistrofia. Nutrição. Terapia anti-retroviral de alta atividade. A B S T R A C T

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Lipodystrophy in patients naive to HIV protease inhibitors

Cited by 175 publications

References 7 publications

Increased serum lipids are associated with higher CD4 lymphocyte count in HIV‐infected women

Increased serum lipids are associated with higher CD4 lymphocyte count in HIV‐infected women

Serum Adiponectin and Leptin Concentrations in HIV-Infected Children with Fat Redistribution Syndrome

Abordagem metabólica e nutricional da lipodistrofia em uso da terapia anti-retroviral

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