ArticlesDiagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: acohort study
Section snippets
Background
The prevalence and severity of lipodystrophy syndrome with long-term therapy for HIV-1 infection that includes a protease inhibitor is unknown. We studied the natural course of the syndrome to develop diagnostic criteria and identifying markers that predict its severity.
Methods
We assessed 113 patients who were receiving HIV-1 protease inhibitors (mean 21 months) and 45 HIV-1-infected patients (28 with follow-up) never treated with a protease inhibitor. Lipodystrophy was assessed by questionnaire
Patients
The study population consisted of 116 HIV-1-infected patients receiving at least one HIV protease inhibitor, who were initially investigated cross-sectionally between August and September, 1997,1 after a mean 13·6 months of therapy, and 45 HIV-1-infected patients who had never received a protease inhibitor (38 of whom were receiving other antiretroviral drugs). Both groups of patients were seen for routine care, and were not selected for any syndrome manifestation. Both groups had no active
Patients
113 (98%) protease-inhibitor recipients were reassessed after a mean 21 months (SD 8) total therapy (table 1). 14 (12%) patients had ceased protease-inhibitor therapy a mean of 3 months (range 1–6) previously, two patients because of lipodystrophy, and 12 because of pill burden, other adverse events, or antiretroviral failure. In 28 of 45 protease-inhibitor-naïve patients, repeat measurements were made after a mean 8 months (SD 1); of those who did not have repeat measurements, 11 had started
Discussion
We found that self-assessment by patients, physical examination, fasting triglycerides and C-peptide, and central abdominal fat mass measured by DEXA were useful in the diagnosis of lipodystrophy syndrome. Predictors of subsequent lipodystrophy severity included weight before protease therapy, the duration of therapy, and fasting triglyceride and C-peptide concentrations on therapy. After almost 2 years of potent HIV-1 protease-inhibitor-containing therapy, lipodystrophy was very common, was
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