French researchers analyzed a cohort of 196 protease inhibitor (PI)-treated patients for factors associated with lipodystrophy, finding that the duration of nucleoside reverse transcriptase inhibitor (NRTI) treatment was associated with abnormalities. Using retrospective analysis, 49 of the patients were identified with either fat wasting (n = 14), truncal adiposity (n = 5) or both (n = 30). Comparing patients with lipodystrophy to those without lipodystrophy, the authors observed that lipid abnormalities were correlated with duration of infection, NRTI experience prior to highly active antiretroviral therapy (HAART), and HAART therapy. Patients with lipoatrophy tended to be younger and had greater exposure to NRTI prior to antiretroviral therapy compared to patients showing adiposity or fat wasting and adiposity. Patients with lipodystrophy also showed increased fasting triglycerides and cholesterol. However, patients without lipodystrophy also had increased fasting triglycerides and cholesterol over the same period.

The data indicate that duration of NRTI therapy is associated with fat wasting. The investigators also noted that elevated triglycerides and cholesterol are independent of lipodystrophy and may be related to PI-exposure, which contrasts with findings presented by Carr and colleagues.