September 27, 2001

HIV Therapy Duration Linked to Fat Abnormalities


NEW YORK (Reuters Health) - The longer HIV-infected patients are on the drug regimen called highly active antiretroviral therapy (HAART), the more likely they are to develop abnormalities in fat distribution, according to researchers in France.

Patients on HAART may develop these abnormalities, called lipodystrophic syndromes or lipodystrophy. Patients with lipodystrophy develop changes in body shape such as sunken cheeks, an increase of fat in the face and around the waist, and the appearance of a fat pad on the back of the neck.

The development of lipodystrophic syndromes is linked with both the length of time a patient is on HAART and the total number of anti-HIV drugs called nucleosides that he or she took before starting HAART, Dr. Jean-Paul Viard of Hopital Necker in Paris and colleagues report.

Viard's team examined the link between HAART and the development of lipodystrophic syndromes in 175 HIV-infected patients. All patients received triple combination therapy that included a protease inhibitor. During an average of 20 months of HAART therapy, 51 of the patients (29%) developed lipoatrophy, truncal fat accumulation or a combination of these syndromes.

Patients with lipoatrophy had a longer duration of HAART exposure; were exposed to a more nucleoside analogs before starting HAART; and had HIV for a longer time, according to the report in the August 15th issue of the Journal of Acquired Immune Deficiency Syndromes.

These patients also had higher fasting blood levels of fats called triglycerides before starting HAART than other patients. Pre-HAART weight and fasting cholesterol levels were higher in patients with mixed syndromes than in others, while patients with mixed syndromes also tended to be older.

Triglyceride and cholesterol levels rose significantly in all patients in the study, whether or not they developed a lipodystrophic syndrome, and appear to depend on protease inhibitor exposure, the authors report.

The study is not the first to suggest that HAART is linked with lipodystrophy in HIV-infected patients, Viard's group points out. The new findings add to existing evidence for this link.