Body habitus changes, metabolic abnormalities, and subclinical coronary atherosclerosis associated with long-term antiretroviral therapy

The public health significance of this work reflects the HIV/AIDS epidemic and growing concerns of long-term consequences of antiretroviral therapy. The advent of highly active antiretroviral therapy (HAART) has greatly improved survival among those with HIV-infection. As a corollary, clinicians and researchers face a range of long-term complications previously of little importance to HIV-infected patients. HIV-associated lipodystrophy syndrome (HIV-LS) was first described in 1998 and involves a constellation of metabolic and morphologic abnormalities. Whereas AIDS wasting syndrome has been associated with immunosuppression and high viral burden, HIV-LS has been documented with immunocompetence and suppressed viral concentration. Participants of the local site of the Multicenter AIDS Cohort Study (MACS) consented to photography of their lipodystrophic body habitus changes during routine clinic appointments. The compilation of these photographs was used to develop a manual for clinicians at all four of the MACS sites in order to accurately document the syndrome, and permitted initial classification of HIV-LS into two phenotypes. A third phenotype was identified following a preliminary observation of lipoaccumulation extending bilaterally and symmetrically from the breasts laterally into the axilla. Additional cases were subsequently identified within the MACS; all subjects had pre-existing lipoaccumulation of at least one other anatomical site. It was speculated as to whether this represented a previously unrecognized evolution of HIV-LS. Our next project involved studying the health related quality of life (HRQL) of men with HIV-LS. We found HIV-LS does not negatively affect HRQL or exacerbate depressive symptoms above and beyond the diagnosis of HIV-infection. The metabolic abnormalities of HIV-LS include insulin resistance and dyslipidemia, both of which are considered pro-atherogenic risks. The final segment of this project involved detecting coronary artery calcification via electron beam computed tomography among HIV-infected men treated with HAART. In this male population with well controlled HIV-infection, chronic use of HAART did not impact the progression of subclinical coronary atherosclerosis. In contrast, traditional atherosclerosis risk factors of smoking and advancing age were predictive of coronary atherosclerosis. HIV-infection requires life-long combination treatment. Clinicians, researchers and patients recognize dyslipidemia, peripheral lipoatrophy and central lipohypertrophy as significant consequences of this combination therapy, and hope that concerns regarding increasing cardiac risk are not warranted