The lipodystrophy syndrome is a syndrome of peripheral fat wasting, hyperlipidemia, insulin resistance, and central adiposity occurring in some patients taking protease inhibitors for HIV-1 infection.


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


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