Lipodystrophy and metabolic syndrome in HIV-infected patients treated with antiretroviral therapy

Abstract

Lipodystrophy (lipo) and metabolic derangements associated with an increased cardiovascular risk are observed frequently in human immunodeficiency virus (HIV)–infected patients who receive antiretroviral treatment (ART). The objective of the study was to provide detailed biochemical information about metabolic syndrome in this condition. One hundred forty-six HIV-infected male and female patients on ART for more than 6 months were compared with 156 body mass index (BMI)–matched healthy subjects. Lipodystrophy was diagnosed upon patient and physician concordance. Metabolic syndrome was defined according to the Adult Treatment Panel III criteria. Plasma adiponectin (AD) and leptin were measured by radioimmunoassay. Insulin resistance (IR) was assessed by the homeostasis model assessment (HOMA). The prevalence of metabolic syndrome was higher in HIV-infected patients on ART than in non–HIV-infected healthy controls (15.8% vs 3.2%; P < .001). Patients with metabolic syndrome are older (44.6 ± 6 vs 39.8 ± 8 years; P = .004), have an increased BMI (24.9 ± 3.8 vs 22.9 ± 9.8 kg/m 2; P = .01), present with a reduced AD-to-leptin ratio log 10 (−0.19 ± 0.4 vs 0.5 ± 0.4; P = .04), and show increased IR (HOMA, 5.6 ± 2.7 vs 3.8 ± 2.2; P = .001; plasma fasting insulin, 22.9 ± 9.8 vs 16.6 ± 9.7 ng/mL; P < .001). In multivariate analysis, the diagnosis of lipo and HOMA were independently and significantly related to metabolic syndrome. In conclusion, the prevalence of metabolic syndrome is significantly increased in HIV-infected patients on ART and its presence is associated with lipo, increased age and BMI, IR, and a reduced plasma AD-to-leptin ratio.