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Objectives: To assess the correlations between the hormone leptin and lipoatrophy in HIV-positive, treatment-naive patients on combination antiretroviral therapy (cART)., Design: Case-control study nested in a multicentre cohort of HIV-infected adults. Cases were patients that developed lipoatrophy and controls those who did not., Patients and Methods: Clinical parameters and plasma leptin determinations were studied in 97 HIV-1-infected, treatment-naive Caucasian men (10 cases and 87 controls) on an unchanged and virologically successful drug regimen with a zidovudine/lamivudine backbone at baseline and after 2 years of cART. The association of plasma leptin levels and the development of lipoatrophy was investigated., Results: Two years of cART was not associated with a change in plasma leptin levels. Plasma leptin levels remained sensible to changes in body mass index. There was no difference in leptin levels between patients who developed lipoatrophy and controls, neither before nor after cART. The only predictor of development of lipoatrophy was a higher age (P = 0.02)., Conclusions: Leptin as measured in plasma is unlikely to play a major role in the genesis of lipoatrophy.

Background: Highly active antiretroviral therapy has brought about a substantial improvement in the prognosis of HIV/AIDS. In this context, therapy-related body changes (lipodystrophy) gain in importance, in light of the psychological distress they cause and of their association with adherence to treatment. This study analyses patients' self-perception of central fat gain (CFG) and peripheral fat loss (PFL)., Methods: A total of 457 patients were interviewed in a university outpatient facility for the treatment of adults and adolescents with HIV/AIDS in the city of São Paulo, Brazil, between September and December 2001., Results: Two-thirds of subjects (64.3%) perceived body changes. The self-perception of CFG and PFL was associated with greater schooling. The self-perception of CFG was more frequent among women and in patients who used protease inhibitors for longer periods. The self-perception of PFL was more frequent among older patients, patients who used stavudine for longer periods, and patients who reported a lack of adherence to antiretroviral agents. The quality of affective/social relationships with friends and family was inversely associated with the self-perception of PFL., Conclusion: The evaluation of self-perceived body changes and their determinants in individuals living with HIV/AIDS may help improve provided care. Listening to what patients have to say concerning antiretroviral therapy-related body changes and how they perceive them, as well as including the patient in therapeutic decisions in this regard will contribute towards greater adherence to proposed interventions and towards an improvement in the quality of life.

HIV lipodystrophy is a heterogeneous syndrome, which has yet to be objectively defined, comprising peripheral lipoatrophy, central fat accumulation and lipomata, along with hyperlipidaemia, insulin resistance and lactic acidaemia. Both nucleoside analogues and protease inhibitors are involved, but there are also host factors that probably place some patients at greater risk. The pathogenesis is increasingly understood, with evidence of interference of several regulatory proteins such as sterol regulatory enhancer binding protein-1, the proteasome, mitochondrial DNA polymerase gamma and GLUT-4. Along with the issues of cosmesis and stigmatization, a principal clinical concern that arises with lipodystrophy is a possible increased risk of accelerated atherosclerosis. A variety of therapeutic interventions, designed to limit these risks, are under evaluation, but none is conclusively shown to be of value.

Objective: To determine liver fat content in patients with highly active antiretroviral therapy (HAART)-associated lipodystrophy., Background: Lipodystrophy in several animal models is associated with fat accumulation in insulin-sensitive tissues, such as the liver. This causes hyperinsulinaemia, dyslipidaemia and other features of insulin resistance., Design: A cross-sectional study., Subjects and Methods: Three age- and weight-matched groups were compared: 25 HIV-positive men with HAART-associated lipodystrophy (HAART+LD+), nine HIV-positive men receiving HAART, but without lipodystrophy (HAART+LD-), and 35 HIV-negative healthy men (HIV-). Liver fat content was measured using proton spectroscopy. Intra-abdominal and subcutaneous fat were determined using magnetic resonance imaging., Results: Liver fat content was significantly higher in the HAART+LD+ (8 +/- 10%) than the HIV- (5 +/- 7%; P < 0.05) or the HAART+LD- (3 +/- 5%; P < 0.01) group. Liver fat content correlated with serum fasting insulin in the HAART+LD+ (r = 0.47; P < 0.05) and HIV- groups (r = 0.65; < 0.001), but not with the amount of intra-abdominal fat. Within the HAART+LD+ group, serum insulin did not correlate with the amount of intra-abdominal fat. The HAART+LD+ group had a lower serum leptin concentration when compared to the two other groups. Features of insulin resistance, including hepatic fat accumulation, were not found in HAART+LD-group., Conclusions: The severity of the insulin resistance syndrome in patients with HAART-associated lipodystrophy is related to the extent of fat accumulation in the liver rather than in the intra-abdominal region. Fat accumulation in the liver may therefore play a causative role in the development of insulin resistance in these patients.