Lipid profile of HIV-1 infected patients under highly active antiretroviral therapy
L. C. R. Pontes
THESIS: L. C. R. Pontes submitted this dissertation for her Masters in Tropical Diseases at Botucatu School of Medicine, São Paulo State University, UNESP, Botucatu, São Paulo, Brazil, 2002.
Advisor: Professor Paulo Câmara Marques Pereira.
Currently available protease inhibitors (PI) are associated with the development of a group of metabolic disorders, such as a peripheral lipodystrophy syndrome, in which there is fat wasting in the face, arms, and legs; fat accumulation in the abdomen, dorso-cervical region, and/or breasts; as well as dislipidemia. Recently, fat wasting has also been observed in patients who have never taken a PI, showing an independent effect of nucleoside analogue reverse transcriptase inhibitor (NRTI) therapy. Some researchers suggest that lipodystrophy may be temporally related to the underlying HIV-1 disease process or to the general suppression of HIV-1 replication by antiretroviral therapy. This study was to analyze the lipid profile, and the clinical and nutritional aspects of HIV-1 infected individuals under treatment with or without PI. Subsequently, the individuals were distributed into four groups: control group (CG), 15 health individuals; group 1 (G1), 11 HIV-infected individuals without antiretroviral therapy; group 2 (G2), 14 HIV-infected individuals with highly active antiretroviral therapy (HAART) with PI; and group 3 (G3), 22 HIV-infected individuals with HAART but without PI. The mean age was 35 years. All individuals were submitted to the following: clinical, hematological, biochemical, and nutritional evaluation; peripheral blood CD4+ lymphocyte counts; plasma HIV RNA viral load assessment; anthropometric measurement; bioelectrical impedance analysis; and inflammatory activity tests. Lipodystrophy was observed in both the with and without PI group; only the group under treatment with PI showed hypertriglyceridemia. There was no significant difference in total cholesterol and LDL cholesterol in any group. However, the groups of HIV-infected subjects had below normal HDL values. The viral load of those under HAART was lower than those without antiretroviral therapy. Men under HAART were classified as overweight according to body mass index. There was no difference between the groups on lean body mass; in contrast, the HIV-infected women had less subcutaneous fat than controls. Women on HAART also had less fat evaluated by arm skinfold than controls. Consequently, we observed an association between lower viral loads in subjects under PI with hypertriglyceridemia. There was no difference between PI and non-PI subjects in relation to lipoatrophy and fat. We suggest that lipodystrophy is related to either PI or NRTI. Further research is required to ascertain if these changes are as a result of antiretroviral therapy (particularly protease inhibitor use) or of several HIV-related syndromes.
Key words: lipodystrophy; HIV-1; highly active antiretroviral therapy; dislipidemia; hypertriglyceridemia.
Publication in this collection
24 Sept 2004
Date of issue