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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Effects of Protease Inhibitors on Hyperglycemia, Hyperlipidemia, and Lipodystrophy: A 5-Year Cohort Study [Tsiodras S, et al. Arch Intern Med 2000; 160: 2050]: This is a report from the Beth Israel Deaconess Medical Center in Boston was designed to examine temporal trends on hyperglycemia, hyperlipidemia, and lipodystrophy during PI therapy. The authors used data from a 5-year historical cohort of 221 HIV-infected patients. The cumulative incidence of new onset hyperglycemia was 5%, for hypercholesterolemia it was 24%, for hypertriglyceridemia it was 19%, and for lipodystrophy is was 13%. Most of these complications occurred after the introduction of protease inhibitor therapy, and all showed a statistically significant association with PI therapy. The results by multivariate analysis to provide relative risk or odds-ratio is shown in the following table:

Variable Risk OR
Hyperglycemia
    (levels >140 mg/dL x 2)		 Age >40
PI use
Pentamidine		 4
5
16.8
Hypercholesterolemia
    (levels >240 mg/dL)		 Baseline elevated
Age >40
PI
Non PI regimen		 3.8
1.9
2.8
2.5
Hypertriglyceridemia
  (levels >500 mg/dL)		 Baseline elevated
PI use		 2.9
6.1
Lipodystrophy Age >40
PI
Anabolic steroids
Psychotropic meds
Hyperlipidemia		 3.5
5.1
3.5
2.9
2.3

Comment: This report, like many others, found an independent association between PI use and hyperlipidemia, lipodystrophy, and hyperglycemia. The temporal sequence is of interest: For hypercholesterolemia, this complication occurred in a linear relationship with the duration of treatment. There were just about no patients with this complication in the first 10 months, the frequency at 20 months was about 15%, at 40 weeks it was about 25%, and at 60 weeks it was about 40%. The same linear trend was noted with hypertriglyceridemia: an incidence of about 10% at 10 months, 15% at 20 months, 35% at 40 months, and 45% at 60 months. The average cholesterol increase was 0.47% per month during PI therapy. These data are useful in planning strategies for testing for hyperlipidemia in patients with HIV infection. posted 7/19/2000







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