8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV San Francisco, California - September 24 - 26, 2006

TNFα AND LEPTIN ARE DECREASED IN HIV-ASSOCIATED LIPODYSTROPHY PATIENTS CLINICALLY AND DEXA FAT MASS RATIO DEFINED

Antiviral Therapy 2006; 11:L28 (abstract no. 42)

P Freitas¹, D Carvalho¹, AC Santos², R Marques³, AJ Madureira⁴, S Xerinda³, R Serrão³, C Gonçalves⁵, I Ramos⁴, H Barros², A Mota-Miranda³ and JL Medina^1
1Departments of Endocrinology, ²Hygiene and Epidemiology, ³Infectious Diseases, ⁴Radiology and ⁵Laboratório Nobre, Hospital São João, Faculdade de Medicina do Porto, Portugal

INTRODUCTION: HIV-related lipodystrophy is characterized by adipose redistribution and metabolic abnormalities. The adipocyte-derived hormones (ADH) might link the changes in adipose distribution and these metabolic abnormalities, namely with insulin-resistance.

AIMS: To evaluate the ADH (adiponectin, leptin, resistin, TNF-a) and Ghrelin in HIV-infected patients under ART 1) in patients with and without lipodystrophy defined clinically and 2) in patients with and without lipodystrophy defined by the fat mass ratio (FMR) (ratio of the fat mass percentage of the trunk over the limbs by DEXA; cut-off value of 1.5).

PATIENTS AND METHODS: One hundred and eight HIV-1 infected patients were evaluated for the presence of clinical lipodystrophy (CL) (78 with CL), lipodystrophy according to FMR (FMRL) (52 with) and abdominal fat distribution by CT.

RESULTS: The patients with lipodystrophy showed a visceral adipose tissue (VAT)/subcutaneous adipose tissue (SAT) ratio by CT scanning significantly higher than the patients without (CL with 2.57 ±3.26 versus without 0.68 ±0.63, P=0,01); FMRL with 2.9 ±3.39 versus without 1.23 ±2.2, P=0.01). TNFα was significantly decreased in the patients with CL (with 66.3 ±43.9 pg/ml versus without 92.4 ±68.59 pg/ml, P=0.01) and FMRL (with 57.2 ±36.2 pg/ml versus without 82.2 ±60.1 pg/ml, P=0.03). Leptin levels were also significantly decreased in the patients with CL (with 3.9 ±3.3 ng/ml versus without 8.9 ±6.9 ng/ml, P<0.001, adjusted to BMI 3.2 ng/ml [CI 2.8–3.8] versus 5.4 ng/ml [CI 4.2–7.0] P<0.001) and FMRL (with 3.3 ±2.0 versus without 7.5 ±6.4 ng/ml, P=0.002, adjusted to BMI 2.9 [2.4–3.3] versus 4.8 [3.9–5.8], P=0.001). Concerning resistin, adiponectin and Ghrelin no statistical differences were observed. Homocystein plasma levels were significantly increased in patients with FMRL (with 10.9 ±4.7 versus 8.4 ±2.9 µmol/l, P=0.003).

CONCLUSION: Leptin is decreased in lipodystrophic HIV patients indicating a reduction in subcutaneous fat mass; the hyperhomocysteinemia is a marker of increased cardiovascular risk; the TNFα levels had controversial date reports in these patients and they probably depend on the inflammatory state of this condition.

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2006-09-24
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