AEGiS-13IAC: Characterization of Metabolic Abnormalities and Coronary Artery Disease Risk Factors in HIV-infected Men and Women with Lipodystrophy.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Characterization of Metabolic Abnormalities and Coronary Artery Disease Risk Factors in HIV-infected Men and Women with Lipodystrophy.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThOrB762)

Hadigan C, Meigs J, Corcoran C, Basgoz N, Davis B, Sax P, Stanley T, Wilson P, D'Agostino R, Grinspoon S
C. Hadigan, Massachusetts General Hospital, 55 Fruit Street, BUL 457B, Boston, MA 02114, USA, United States, Tel.: +(617) 724-6091, Fax: +(617) 726-5072, E-mail: chadigan@partners.org

BACKGROUND: The HIV-lipodystrophy syndrome is characterized by increased trunk and neck fat and/or loss of extremity and facial fat. Studies suggest that fat redistribution is accompanied by multiple metabolic abnormalities. We characterized metabolic parameters of affected HIV patients compared to age, sex and body mass index (BMI)-matched healthy controls.

METHODS: Seventy-one HIV-infected patients (49 men, 22 women) with fat redistribution were compared to 213 subjects from the Framingham Offspring Study. Fasting glucose, insulin, lipids, 2-hour glucose and insulin response to a 75 gm oral glucose challenge, waist, and hip circumferences were measured for all subjects.

RESULTS: HIV-infected patients had increased waist to hip ratio (WHR) (0.97 é 0.01 HIV vs 0.90 é 0.01 control `mean é sem', P>0.001) and multiple metabolic abnormalities consistent with insulin resistance, including increased fasting insulin (18.1 é 1.8 vs 8.1 é 0.6, P>0.001), 2-hour insulin (98.0 é 11.6 vs 42.4 é 2.8 m U/mL, P>0.001), 2-hour glucose (134 é 5 vs 96 é 2 mg/dL, P>0.001), cholesterol (229 é 7 vs 195 é 2 mg/dL, P>0.001), triglyceride (332 é 37 vs 120 é 4 mg/dL, P>0.01), diastolic blood pressure (77 é 1 vs 74 é 1 mmHg, P = 0.047) and reduced levels of HDL cholesterol (37 é 1 vs 48 é 1 mg/dL, P>0.001). Differences in fasting insulin, 2-hour insulin and glucose, cholesterol and triglyceride remained significant after adjustment for differences in WHR. HIV-infected subjects were more likely to have impaired glucose tolerance (2-hour blood glucose >140 mg/dL; OR 6.5 `95%CI 2.9-14.6', P>0.001) compared to controls, after adjusting for WHR.

CONCLUSIONS: This study documents a metabolic syndrome characterized by hyperinsulinemia and hyperlipidemia, indicative of profound insulin resistance among HIV-infected patients with fat redistribution. Risk factors for coronary artery disease are markedly elevated in such patients compared to a healthy population and are not fully attributable to central fat redistribution.

Keywords: AEGIS, Lipodystrophy, HIV Infections, Blood Glucose, Insulin, HIV Seropositivity, Insulin Resistance, Hyperinsulinism, Glucose, Body Mass Index, Glucose Tolerance Test, Lipids, Risk Factors, Fasting, Fats, Hypoglycemic Agents, Lipoproteins, HDL Cholesterol, HIV-Associated Lipodystrophy Syndrome, Case-Control Studies, Human, Female, Male, abnormalities
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ThOrB762