Protease inhibitors associated with the syndrome:
(1) indinavir
(2) ritonavir-saquinavir combination
Criteria for protease inhibitor associated lipodystrophy syndrome:
(1) one or more physical features developing since the start of HIV-1 protease inhibitor therapy
(2) one or more metabolic features developing since the start of HIV-1 protease inhibitor therapy
(3) no exclusionary conditions within 3 months of assessment
Physical features:
(1) fat wasting of the face, arms, legs or buttocks, which may be associated with prominence in the veins of the arms or legs
(2) fat accumulation in the abdomen or over the dorsolateral spine ("buffalo hump")
Metabolic features:
(1) fasting hyperlipidemia with cholesterol >= 5.5 mmol/L or triglycerides >= 2.0 mmol/L
(2) fasting C-peptide > 2.5 nmol/L (see Note)
(3) impaired fasting glucose (6.1 - 7.0 mmol/L) or diabetes mellitus (>= 7.0 mmol/L) on fasting blood glucose
(4) impaired glucose tolerance (glucose 7.8 - 11.1 mmol/L) or diabetes mellitus (glucose >= 11.1 mmol/L) in the 2-hour specimen during an oral glucose tolerance test
NOTE: The original table gives the fasting C-peptide level as 2.5 mmol/L. Tietz reports the normal range of C-peptide as 0.26-0.63 nmol/L (nanomoles per liter) using a molecular weight of C-peptide as 3,000. This is a10^6-fold difference. A similar normal range in nmol/L is given by Coppack.
Exclusionary conditions:
(1) AIDS-defining event
(2) severe clinical illness
(3) use of anabolic steroids, glucocorticoids or immune modulators
