• Lipodystrophy Syndrome (Abstract PL11)
  Speaker: D. Cooper
  Authored by Cooper, D.; NCHECR, Univ. of New South Wales, Sydney, Australia

Dr. Cooper from Australia gave an overview of lipodystrophy syndrome and how our understanding of this problem has advanced over the last couple of years. We are still struggling with the lack of a clear definition. We need one because that is the only way we are going to be able to quantify the frequency of this problem when patients start different regimens. Having this information would allow us to select regimens less frequently associated with lipodystrophy, and will also help in developing intervention trials, because we will be able to enroll patients with a clear syndrome and quantify the effects of specific interventions. Two studies, one in the US (FRAM) and the other an international study lead by the Australian group of Dr. Cooper, are trying to come out with a definition. It is likely that we will have the results of these trials during the next year. Hopefully this will add clarity to the field.

Then Dr. Cooper summarized some of the most important papers published during the year that provide insight into the basic mechanisms of this problem. He explained how indinavir produces insulin resistance in healthy volunteers after one month of administration, basically proving that protease inhibitors play a central role in the development of insulin resistance, and that HIV itself is not responsible for it (or at least it plays a less important role).

He briefly discussed a paper from Murata that suggests that protease inhibitors produce insulin resistance by affecting GLU4, one of the transporters of glucose in the muscle cells. He also talked about lipodystrophy, with its two "faces": fat accumulation in the abdomen and fat lipoatrophy in the extremities.

In lipodystrophy the issues are less clear, and both protease inhibitors and nucleoside analogs (and maybe HIV itself) probably play a role. He also presented some promising data for the use of troglitazone for the treatment of this enormously important problem for our patients. Then he tried to put everything together in simplistic slides, but it is clear that the problems are still very complex, and the mechanisms that mediate them poorly understood.

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