AIDSWEEKLY Plus; Monday, October 27, 2003
Staff Medical Writers

"Protease inhibitor-based highly active antiretroviral therapy (PI-HAART) has been implicated in dyslipidemia, peripheral insulin resistance, and abnormal adipose tissue deposition in human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome, or AIDS," scientists in St. Louis explained. "In vitro evidence indicates that some PIs reduce adipocyte lipoprotein (LPL) and hepatic lipase (HL) expression and activities."

K.E. Yarasheski and colleagues at Washington University "examined whether LPL and HL activities are reduced in HIV-infected patients with dyslipidemia."

"Fasting serum lipids, glucoregulatory hormones, and postheparin LPL and HL activities, as well as whole body and regional adiposity, were measured in 19 HIV-seronegative controls, 9 HIV+ patients naive to all anti-HIV medications, 9 HIV+ patients naive to PIs, 9 HIV+ patients with prior PI experience but not currently receiving PIs, and 47 HIV+ patients receiving PI-HAART," they noted.

"The PI-HAART group had low LPL and HL activities. However, multiple linear regression analysis indicated that low postheparin LPL activity contributed only partially to HIV-dyslipidemia," study data showed. "Central adiposity and high C-peptide levels (an indicator of high insulin secretion) were stronger predictors of HIV-dyslipidemia."

"Low LPL and HL activities, by themselves, were insufficient to explain HIV-dyslipidemia because the PI-naive group had low LPL and HL activities but had normal adiposity, C-peptide levels, and serum lipid and lipoprotein levels," according to the report. "HDL-cholesterol was lower in PI-HAART and PI-naive groups than seronegative controls and was directly associated with LPL activity."

"These findings suggest that HIV-dyslipidemia is mediated primarily by factors that influence triglyceride and lipoprotein synthesis (e.g., central adiposity and hyperinsulinemia) and mediated only partially by factors that influence triglyceride clearance (e.g., lipase activity)," the researchers concluded.

Yarasheski and coauthors published their study in American Journal of Physiology - Endocrinology and Metabolism (Visceral adiposity, C-peptide levels, and low lipase activities predict HIV-dyslipidemia. Am J Physiol Endocrinol Metab. 2003 Oct;285(4):E899-905.

For more information, contact K.E. Yarasheski, Washington University, School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Division of Endocrinology, Metabolism, and Lipid Research, 660 S. Euclid Avenue, Box 8127, St. Louis, MO 63110 USA.

Publisher contact information for the American Journal of Physiology - Endocrinology and Metabolism is: American Physiological Society, 9650 Rockville Pike, Bethesda, MD 20814 USA.

The information in this article comes under the major subject areas of Adverse Drug Effects, AIDS & HIV, Endocrinology, Insulin, Lipid Studies and Virology.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Yarasheski KE, Tebas P, Claxton S, et al. "Visceral adiposity, C-peptide levels, and low lipase activities predict HIV-dyslipidemia", Am J Physiol Endocrinol Metab. 2003 Oct;285(4):E899-905

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