Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm D J, Cooper D A
HIV Medicine Unit and Centre for Immunology, St Vincent's Hospital, Sydney, Australia.
AIDS. 1998 May 7;12(7):F51-8. doi: 10.1097/00002030-199807000-00003.
To describe a syndrome of peripheral lipodystrophy (fat wasting of the face, limbs and upper trunk), hyperlipidaemia and insulin resistance in patients receiving potent HIV protease inhibitor therapy.
Cross-sectional study.
Outpatient clinic of a university teaching hospital.
HIV-infected patients either receiving at least one protease inhibitor (n=116) or protease inhibitor-naive (n=32), and healthy men (n=47).
Lipodystrophy was assessed by physical examination and questionnaire and body composition by dual-energy X-ray absorptiometry. Fasting triglyceride, cholesterol, free fatty acid, glucose, insulin, C-peptide and fructosamine levels, other metabolic parameters, CD4 lymphocyte counts, and HIV RNA load were also assessed.
HIV protease inhibitor-naive patients had similar body composition to healthy men. HIV protease inhibitor therapy was associated with substantially lower total body fat (13.2 versus 18.7 kg in protease inhibitor-naive patients; P=0.005), and significantly higher total cholesterol and triglyceride levels. Lipodystrophy was observed clinically in 74 (64%) protease inhibitor recipients after a mean 13.9 months and 1(3%) protease inhibitor-naive patient (P=0.0001). Fat loss occurred in all regions except the abdomen after a median 10 months. Patients with lipodystrophy experienced a relative weight loss of 0.5 kg per month and had significantly higher triglyceride, cholesterol, insulin and C-peptide levels and were more insulin-resistant than protease inhibitor recipients without lipodystrophy. Patients receiving ritonavir and saquinavir in combination had significantly lower body fat, higher lipids and shorter time to lipodystrophy than patients receiving indinavir. Three (2%) patients developed new or worsening diabetes mellitus.
A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance is a common complication of HIV protease inhibitors. Diabetes mellitus is relatively uncommon.
描述接受高效抗逆转录病毒治疗的HIV蛋白酶抑制剂治疗患者的外周脂肪营养不良综合征（面部、四肢和上躯干脂肪消耗）、高脂血症和胰岛素抵抗。
横断面研究。
大学教学医院门诊。
接受至少一种蛋白酶抑制剂的HIV感染患者（n = 116）或未接受过蛋白酶抑制剂治疗的患者（n = 32），以及健康男性（n = 47）。
通过体格检查和问卷调查评估脂肪营养不良，并通过双能X线吸收法评估身体成分。还评估了空腹甘油三酯、胆固醇、游离脂肪酸、葡萄糖、胰岛素、C肽和果糖胺水平、其他代谢参数、CD4淋巴细胞计数和HIV RNA载量。
未接受过HIV蛋白酶抑制剂治疗的患者与健康男性的身体成分相似。HIV蛋白酶抑制剂治疗与全身脂肪显著降低相关（未接受过蛋白酶抑制剂治疗的患者为18.7 kg，接受治疗的患者为13.2 kg；P = 0.005），总胆固醇和甘油三酯水平显著升高。在平均13.9个月后，74例（64%）接受蛋白酶抑制剂治疗的患者临床上出现脂肪营养不良，1例（3%）未接受过蛋白酶抑制剂治疗的患者出现脂肪营养不良（P = 0.0001）。在中位10个月后，除腹部外的所有部位均出现脂肪减少。有脂肪营养不良的患者每月相对体重减轻0.5 kg，甘油三酯、胆固醇、胰岛素和C肽水平显著更高，且比没有脂肪营养不良的蛋白酶抑制剂治疗患者更具胰岛素抵抗性。联合使用利托那韦和沙奎那韦的患者比接受茚地那韦的患者身体脂肪更低、血脂更高且出现脂肪营养不良的时间更短。3例（2%）患者出现新发或恶化的糖尿病。
外周脂肪营养不良、高脂血症和胰岛素抵抗综合征是HIV蛋白酶抑制剂的常见并发症。糖尿病相对不常见。
