TreatmentUpdate83 - Vol. 9, No. 9 - pp. 1-2; November 1997
Sean Hosein

As more people use protease inhibitors, the range of side effects associated with these drugs increases. In addition to changes in triglyceride, cholesterol and blood sugar levels, the use of protease inhibitors has recently been associated with changes in body shape. Increased fat around the abdomen, commonly called 'Crix belly', and reduced muscles on the arms and legs are often noted by people who take protease inhibitors. As well, some women experience breast enlargement. Although these changes resemble a condition called Cushing's syndrome, where high levels of the hormone cortisol are produced, people with Crix belly do not appear to have Cushing's syndrome. At this time, researchers are in fact not certain about the exact cause(s) of the changes in body shape seen with the use of protease inhibitors. A severe case of breast enlargement, which is detailed below, cleared when the patient stopped using indinavir (Crixivan).

Body Shape Changes

Five months after beginning triple therapy with 3TC, d4T and indinavir, a 32-year-old woman who had been infected with HIV for 10 years complained to her doctor about the increased size of her breasts. On examination, the doctor found them to be swollen, red and painful. As the woman's breasts grew so did her abdomen, although her overall body weight remained the same. Meanwhile, her thighs and buttocks became thinner. Her menstrual cycle was normal as were the results of a mammogram and several hormones tests--prolactin and Beta-HCG [human chorionic gonadotropin]. Suspecting indinavir was the cause of her problems, the women's doctors advised her to quit the drug while continuing to use 3TC and d4T. Two months later her breasts had returned to their normal size and the skin was no longer red and painful. As well, the shape of her abdomen, thighs and buttocks partly "returned to their initial shape." Obviously, the companies that make these drugs should study the changes in body shape associated with their use to find a way to counteract these side effects.

REFERENCES:

1. Herry I, Bernard L, de Truchis P and Perrone C. Hypertrophy of the breasts in a patient treated with indinavir. Clinical Infectious Diseases 1997;25:937-938.

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