• Does Race Protect an Asian Population from Developing Lipodystrophy in HIV-Infected Individuals on HAART? (Poster 648)
  Authored by K. Chang, J. Kim, S. Hong, Y. Song, H. Lee, and S. Lim
  View the original abstract

Several presentations during this conference have started to address the issue of genetic polymorphisms and predisposition to hyperlipidemia or high drug levels (see abstract 260 and abstract 500). Changes in body composition are probably also be genetically predisposed. In this study, the authors looked at the frequency of body fat changes, lipodystrophy, and multiple metabolic parameters in Asian patients in a single clinic in Korea. The study was cross-sectional and classified the patients as naive, protease-inhibitor-treated, and protease-inhibitor-spared on therapy. To their surprise (and mine) they observed a strikingly low frequency of these complications.

Why is this?

This could be due to genetic factors, but there could be several confounders. Diet could play a significant role. It should not be big news to anybody that the "normal" American diet (and by that I mean a McDonald's Big Mac here and there) is not extremely healthy for your lipids, and, by the same token, for your body fat. Another potential confounder is the length of previous antiretroviral use, which is longer in the HIV-infected patients this side of the Pacific Ocean. The Korean patients already have evidence of insulin resistance and hypertrigliceridemia, which are probably early markers of things that are coming.

In any case, the study is important. For the same reasons that it is important to confirm the efficacy of antiretroviral medications in different populations, it is also important to see if there are differences in the frequency of the toxicities and metabolic complications of treatment. If we understand these differences (if there are any), and the relative importance of genetics vs. environmental factors, we might be able to better understand the pathogenesis of these disorders, and intervene to prevent their apparition.