Endocrinopathies in patients receiving HAART

Poster session abstracts 407 - 416

6 reports described a syndrome of fat redistribution variably called "multiple symmetrical lipomatosis," "protease paunch," "buffalo" or "cervical hump," and "peripheral lipodystrophy." The syndrome incidence was estimated by two authors as between 11% and 64% of all patients receiving HAART. Risk factors for development of the syndrome included older age in one study (Rosenberg, poster 408) and duration of time receiving HAART in another study (Carr, poster 410). In addition, the latter authors found that combination PI therapy with saquinavir-ritonavir was the therapy most associated with development of the syndrome (poster 410).

Endocrinologic evaluation was undertaken by all investigators. Routine assessment of adrenal, gonadal, and thyroid axes was unrevealing in all studies, as were glucose levels. One group (poster 410) found evidence of insulin resistance, demonstrated by clinical appearance, and elevation of insulin and C-peptide levels among cases as compared to controls.

All 4 protease inhibitors have been associated with the syndrome. An FDA summary of 12 reported cases (Mann, poster 412) also emphasized that the risks and underlying endocrinopathic abnormalities for the syndrome were poorly understood. Additional investigation is ongoing.

The incidence of diabetes mellitus among persons receiving HAART was defined at about 2% by Keruly (poster 415) among 417 patients in Baltimore. This and related study (Dong, poster 416) noted development of diabetes with all PI's.

These studies again demonstrate that the side effects of any class of medications can be known only after years of widespread medication use. Understanding risk, etiology, and, hopefully soon, developing an effective intervention for these endocrinopathies is an urgent priority in AIDS care.