Vascular and Lipid Syndromes in Selected HIV-Infected Patients

Abstract

Abizarre and unexpected set of vascular and lipid syndromes appears to afflict an as-yet-undetermined percentage of HIV-infected patients taking what is called highly active antiviral therapy. The syndromes, the subject of several presentations at the 12th World AIDS Conference in Geneva, Switzerland, were among the most serious side effects of the therapy that has revolutionized AIDS treatment in industrialized nations. HAART, as the treatment is more generally known, usually consists of 2 nucleoside reverse-transcriptase inhibitors and a protease inhibitor. Usually, 1 of the reverse-transcriptase inhibitors crosses the blood-brain barrier. These drugs interfere with the life cycle of the retrovirus at the point at which RNA is translated into the DNA that can be incorporated into the genetic blueprint of the cell. Protease inhibitors work later in the life cycle of the virus, preventing release of virions from the cellular machinery that has been subverted into a virus factory. The syndrome consists of a lipodystrophy, with fat disappering from the limbs and distant areas of the body while concentrating in the trunk. There are often unusual fat deposits in the abdomen and a “buffalo hump” of fat in the upper shoulders. There were also some levels of serious insulin resistance and, in some cases, frank diabetes mellitus associated with the syndrome. Of even greater concern are high cholesterol and triglyceride levels—above where most physicians in the world would begin to treat, said David Cooper, MD, immediate past president of the International AIDS Society and a practicing physician at …