Cardiovascular Disease Risk Factors Among HIV Patients

Metabolic disturbances and fat redistribution have been characterized in HIV-infected patients receiving combination antiretroviral therapy according to drug exposure and patterns of fat redistribution. In contrast, we investigated metabolic abnormalities in a well-characterized cohort of HIV-infected patients with clinical lipodystrophy in comparison with an established population of healthy control subjects with known cardiovascular disease (CVD) risk parameters. In order to establish the extent of lipid abnormalities, glucose intolerance, and increased CVD risk in HIV-infected men and women experiencing lipodystrophy, we evaluated metabolic and clinical parameters in comparison with healthy control subjects. We investigated sex-specific differences in CVD risk parameters and the extent to which fat redistribution contributes to the metabolic abnormalities in HIV infected men and women with lipodystrophy syndrome. This study demonstrates a constellation of metabolic abnormalities, including hyperinsulinemia and dyslipidemia, suggestive of a significant insulin resistance syndrome among HIV-infected patients with fat redistribution. In comparison, cardiovascular risk parameters are not substantially increased in HIV-infected patients without clinical evidence of fat redistribution. Although affected patients have a significant increase in waist-to-hip ratio, the observed metabolic abnormalities persist after adjustment for increased waist-to-hip ratio in male patients, and to a lesser degree in female patients, and may result from loss of peripheral or subcutaneous fat.