Triglyceride increase can predict lipodystrophy in HIV patients under highly active antiretroviral therapy

The development of lipodystrophy in HIV patients under highly active antiretroviral therapy (HAART) is an important problem associated with this therapy.

Several authors have found inconclusive results when studying the metabolic mechanisms allied with those morphological changes. In order to establish a possible association between changes in serum lipids and lipodystrophy, the authors investigated their evolution in HIV patients receiving HAART.

Of 297 HIV patients receiving HAART, researchers selected 90 subjects in whom adherence to antiretroviral drugs was deemed adequate (more than 95% compliance). Follow-up included baseline and three monthly determinations of serum cholesterol and triglyceride levels. Lipodystrophy was diagnosed when the patient and doctor agreed on the presence of facial or limb lipoatrophy with or without increased deposits of fat in the abdomen or trunk. Patients were considered to have high cholesterol and triglyceride serum levels when their values were over 240 and 200 mg/dl, respectively.

A total of 63.3% of the patients were men; the mean age was 38 years (range 21-64). Follow-up was 858 215 days (range 364-1,445). Overall, 62.8% of the patients showed lipid abnormalities: high triglyceride levels, 42%; high cholesterol levels 39%; high cholesterol and triglyceride levels, 24.2%. Triglyceride levels increased after 229 144 days (range 35-825) and cholesterol levels increased after 248 134 days (range 30-714) of starting HAART. Thirty-seven patients (40.7%) evolved to lipodystrophy after 488 165 days (range 185-1084) of treatment. By the time lipodystrophy was diagnosed 79% of patients presented with hypertriglyceridemia, and 51.7% presented with hypercholesterolemia (NS). Hypertriglyceridemia starting after six months of therapy was significantly associated with lipodystrophy. Multivariate analysis confirmed these findings.

In the group with lipodystrophy, the number of patients with abnormally high triglyceride levels was progressively increasing during the time of observation: seven in month 3; 13 in month 6; 22 in month 12; and 24 in month 18. Eight patients with hypertriglyceridemia did not develop lipodystrophy. No differences were found between the lipodystrophy pattern or severity and the type of metabolic changes.

The authors of the study concluded that “an increase in triglyceride levels and the development of lipodystrophy followed a significant progressive and parallel course, and even that an increase in triglyceride levels could be considered a predictive marker of this event in many patients receiving HAART.”