Lipodystrophy and metabolic abnormalities in Slovenian HIV-infected patients

The purpose of this cross-sectional survey was to estimate the prevalence of lipodystrophy (LD) and metabolic abnormalities in Slovenian patients with HIV infection. All patients receiving highly active antiretroviral therapy (HAART) for more than six months (treated group) and all known antiretroviral-naive patients (control group) were consecutively evaluated between October and December 2003. Eighty-one treated patients (81% male, 19% female), and 18 controls (83% male, 17% female) were included in the study. In the treated group, the duration of HAART at the time of evaluation was 3.7 ± 2.3 years. Twenty-nine treated patients (36%) had at least one sign of LD: isolated peripheral atrophy was present in nine (31%), isolated fat accumulation in four (14%) and a mixed syndrome in 16 (55%). Patients with evidence of LD were older than those without LD and had a higher prevalence of AIDS and a longer duration of HAART, but there were no differences in HIV transmission categories, plasma RNA level, CD4+ count, HAART regimens or BMI. Insulin resistance was observed in 31 treated patients (38%), of whom 22 (27%) had impaired glucose tolerance and six (7%) had diabetes mellitus. Dyslipidemia was the predominant metabolic abnormality in the treated group, observed in 58 patients (72%). Levels of total cholesterol were increased in 43 patients (53%), and hypertriglyceridemia was noted in 40 (49%). The duration of HAART in patients with metabolic syndrome was longer than in patients without the syndrome. Lipid- and glucose-related abnormalities were more frequent in patients with LD than in those without. A total of 60 treated patients (74%) had at least one sign of LD and/or one metabolic alteration at the time of evaluation. In the control group, none of the patients showed evidence of LD, and metabolic abnormalities were less common than in the treated group: six patients (33%) had one or more metabolic abnormalities. HIV-related LD syndrome includes a variety of clinical and biological manifestations which can be included in a case definition. The metabolic effects of HAART could lead to an increase in cardiovascular disease. The patient’s metabolic parameters should be evaluated before starting treatment, and appropriate management of LD and glucose- or lipid-related metabolic changes is essential.