Various Mechanisms Responsible for Lipodystrophy in HIV-Infected Patients

Most studies of lipodystrophy in HIV-infected patients have emphasized a connection between antiretroviral therapy, while some have suggested that lipodystrophy is associated with HIV-1 disease stage, baseline viral load or pre-existing alterations in body fat distribution. Recently, however, French researchers reported that factors such as HIV-1 load and age, as well as antiretroviral therapy with or without protease inhibitors, are linked with the development of lipodystrophy among HIV-1 infected patients. The researchers, whose findings were published in the July/August issue of HIV Clinical Trials (2001; 2: 339-345), said many questions about the association between lipodystrophy and HIV-1 infection are still unanswered.

According to Dr. Faroudy Boufassa and colleagues, "Particular factors have been thought to cause this syndrome [lipodystrophy]. But the evidence points to a multifactor origin." Boufassa's group conducted a cross-sectional study of 685 HIV-1 infected men and women who were receiving outpatient antiretroviral treatment at six Paris hospitals between January and May of 1999. Clinical lipodystrophy was diagnosed in 58.8 percent of patients. Of these, 64 percent were receiving protease inhibitors, while 40.9 percent had never received them. Multivariate analysis revealed that older age, low HIV RNA level at assessment, duration of antiretroviral therapy, and treatment with antiretroviral combinations that included protease inhibitors or stavudine, were independent predictors of lipodystrophy. Identifying the role of the various mechanisms involved in lipodystrophy is crucial to finding ways to reduce the risk of cardiovascular disease, which is likely to be increased in HIV-1 infected patients with lipodystrophy.

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