Increasing Triglycerides Predict Lipodystrophy
Increasing Triglycerides Predict Lipodystrophy
The development of lipodystrophy in HIV-infected patients receiving HAART is an important problem. Results from studying the metabolic mechanisms allied with those morphologic changes have been inconclusive in several investigations. To establish a possible association between changes in serum lipids and lipodystrophy, Rodriguez-Guardado and colleagues investigated the evolution of these changes in HIV-infected patients receiving HAART (AIDS. 2002;16:1434-1436).
Of 297 HIV-infected patients receiving HAART, the researchers selected 90 in whom adherence to antiretroviral drugs was deemed adequate (more than 95% compliance). Follow-up included baseline and 3 monthly determinations of serum cholesterol and triglyceride levels. Lipodystrophy was diagnosed when the patient and doctor agreed on the presence of facial or limb lipoatrophy with or without increased deposits of fat in the abdomen or trunk. Patients were considered to have high serum cholesterol and triglyceride levels when these values were over 240 and 200 mg/dL, respectively.
A total of 63.3% of the patients were men; the mean age was 38 years (range, 21 to 64 years). Follow-up was 858 ± 215 days (range, 364 to 1445 days). Overall, 62.8% of the patients showed lipid abnormalities: high triglyceride levels, 42%; high cholesterol levels, 39%; high cholesterol and triglyceride levels, 24.2%. Triglyceride levels increased within 229 ± 144 days (range, 35 to 825 days), and cholesterol levels increased within 248 ± 134 days (range, 30 to 714 days) after starting HAART. Changes in 37 patients (41%) evolved to lipodystrophy after 488 ± 165 days (range, 185 to 1084 days) of treatment. At the time lipodystrophy was diagnosed, 79% of patients presented with hypertriglyceridemia, and 51.7% presented with hypercholesterolemia. Hypertriglyceridemia beginning after 6 months of therapy was significantly associated with lipodystrophy. Multivariate analysis confirmed these findings.
In the group with lipodystrophy, the number of patients with abnormally high triglyceride levels progressively increased during the time of observation: 7 in month 3, 13 in month 6, 22 in month 12, and 24 in month 18. In 8 of the patients with hypertriglyceridemia, lipodystrophy did not develop. No differences were found between the lipodystrophy pattern or severity and the type of metabolic changes.
The authors concluded that "an increase in triglyceride levels and the development of lipodystrophy followed a significant progressive and parallel course, and even that an increase in triglyceride levels could be considered a predictive marker of this event in many patients receiving HAART." [CDC HIV/STD/TB Prevention News Update, Monday, July 1, 2002]
The development of lipodystrophy in HIV-infected patients receiving HAART is an important problem. Results from studying the metabolic mechanisms allied with those morphologic changes have been inconclusive in several investigations. To establish a possible association between changes in serum lipids and lipodystrophy, Rodriguez-Guardado and colleagues investigated the evolution of these changes in HIV-infected patients receiving HAART (AIDS. 2002;16:1434-1436).
Of 297 HIV-infected patients receiving HAART, the researchers selected 90 in whom adherence to antiretroviral drugs was deemed adequate (more than 95% compliance). Follow-up included baseline and 3 monthly determinations of serum cholesterol and triglyceride levels. Lipodystrophy was diagnosed when the patient and doctor agreed on the presence of facial or limb lipoatrophy with or without increased deposits of fat in the abdomen or trunk. Patients were considered to have high serum cholesterol and triglyceride levels when these values were over 240 and 200 mg/dL, respectively.
A total of 63.3% of the patients were men; the mean age was 38 years (range, 21 to 64 years). Follow-up was 858 ± 215 days (range, 364 to 1445 days). Overall, 62.8% of the patients showed lipid abnormalities: high triglyceride levels, 42%; high cholesterol levels, 39%; high cholesterol and triglyceride levels, 24.2%. Triglyceride levels increased within 229 ± 144 days (range, 35 to 825 days), and cholesterol levels increased within 248 ± 134 days (range, 30 to 714 days) after starting HAART. Changes in 37 patients (41%) evolved to lipodystrophy after 488 ± 165 days (range, 185 to 1084 days) of treatment. At the time lipodystrophy was diagnosed, 79% of patients presented with hypertriglyceridemia, and 51.7% presented with hypercholesterolemia. Hypertriglyceridemia beginning after 6 months of therapy was significantly associated with lipodystrophy. Multivariate analysis confirmed these findings.
In the group with lipodystrophy, the number of patients with abnormally high triglyceride levels progressively increased during the time of observation: 7 in month 3, 13 in month 6, 22 in month 12, and 24 in month 18. In 8 of the patients with hypertriglyceridemia, lipodystrophy did not develop. No differences were found between the lipodystrophy pattern or severity and the type of metabolic changes.
The authors concluded that "an increase in triglyceride levels and the development of lipodystrophy followed a significant progressive and parallel course, and even that an increase in triglyceride levels could be considered a predictive marker of this event in many patients receiving HAART." [CDC HIV/STD/TB Prevention News Update, Monday, July 1, 2002]