1st International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 26–28 June 1999 - San Diego, CA, USA

TWO CASE REPORTS OF UNUSUAL LIPOMATOUS GROWTHS ASSOCIATED WITH COMBINATION ANTIRETROVIRAL THERAPY

Antiviral Therapy 1999; 4(Suppl. 2):56(abstract no. 42)

D Milano¹, JB Finkelstein³, DC Cerriero¹ and L Fontana^2
1Housing Works, ADHC, New York, New York; ²Cabrini Medical Center, New York, New York; and ³Serono Laboratories, Norwell, Massachusetts, USA

Fat maldistribution syndrome (FMS), associated with antiretroviral therapy (ARV), is characterized by peripheral lipodystrophy, enlarged dorsocervical fat pads, visceral fat accumulation, breast enlargement and multiple lipomatoses. Solitary lipomas have not previously been associated with the syndrome. Simple lipomas rarely involve the face or distal extremities and do not appear until fourth decade of life. We describe patients in whom lipomas developed while on ARV. Patient 1: 31 year old male diagnosed HIV-positive in October 1994. CD4 count 326 cells/mm³. Single nucleosiae therapy was initiated in November 1994. Several protease inhibitors were tried in 1996, but discontinued owing to intolerance. In May 1997 nelfinavir was added to stavudine/lamivudine, providing a stable regimen. Viral load (VL) dropped from 7.3×10⁴ to <25 copies/ml. After 10 months, this patient complained of a growth on right forehead and increasing abdominal girth. In September 1998 6 mg once daily recombinant human growth hormone (rhGH) was initiated. Lipoma size was reduced and abdominal girth decreased at 8 weeks of therapy. Lipoma was 40×42 mm at week 8, and 35×35 mm at week 21. Patient 2: 37 year old male diagnosed HIV-positive in April 1998. At initiation of ARV in May 1998, CD4 count was 96 cells/mm³, VL 2.7×10⁵ copies/ml. Started zidovudine/lamivudine in May 1998. Indinavir and delavirdine added in July and November 1998, respectively. VL dropped to <400 copies/ml in December 1998. Patient complained of fatty growths on metatarsal aspects of feet in October 1998. Size of lipomas in February 1999 averaged 21 mm in diameter.

DISCUSSION: Presence of lipomas in the subcutaneous compartment suggests (i) an altered mechanism for growth stimulation; (ii) protected compartment in the presence of peripheral fat depletion; or (iii) different molecular/genetic make-up of the lipocytes within a lipoma. Of interest is the regression of the lipoma in patient 1 with rhGH therapy, coinciding with reduced abdominal girth and presumably, regression of mesenteric fat.

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