BACKGROUND Lipodystrophy is common in HIV-infected patients receiving protease inhibitors (PIs), stavudine, and zidovudine. Adipocytokines may be altered in lipodystrophy. We evaluated risk factors, adipocytokine levels, insulin resistance, and lipid profiles in HIV-infected adolescents with different lipodystrophy types. METHODS A cross-sectional study was conducted in 80 perinatally HIV-infected adolescents receiving PI-based highly active antiretroviral therapy for ≥ 6 months. Patients underwent oral glucose tolerance tests and measurements of high-molecular-weight (HMW) adiponectin, leptin, resistin, insulin, and lipids. They were classified into 3 groups based on the clinical findings: no lipodystrophy, isolated lipoatrophy, and any lipohypertrophy (isolated lipohypertrophy or combined type). RESULTS Of the 80 patients (median age, 16.7 years), 18 (22.5%) had isolated lipoatrophy, while 8 (10%) had any lipohypertrophy (four with isolated lipohypertrophy, and four with the combined type). In a multivariate analysis, longer exposure to stavudine (OR: 1.03; 95% CI, 1.01-1.06; p = 0.005) and indinavir (OR: 1.03; 95% CI, 1.01-1.06; p = 0.012) were associated with lipoatrophy, while longer exposure to didanosine (OR: 1.04; 95% CI, 1.01-1.08; p = 0.017) and indinavir (OR: 1.10; 95% CI, 1.00-1.21; p = 0.045) were associated with any lipohypertrophy. Leptin levels were highest in the any-lipohypertrophy group and lowest in the isolated-lipoatrophy group (p = 0.013). HMW adiponectin levels were significantly lowest in the any-lipohypertrophy group and highest in the no-lipodystrophy group (p = 0.001). There were no significant differences in the levels of resistin among the three groups (p = 0.234). The prevalence of insulin resistance (p = 0.002) and prediabetes/diabetes (p < 0.001) were significantly highest in the any-lipohypertrophy group. Patients with lipoatrophy and those without lipodystrophy had comparable degrees of insulin resistance (p = 0.292). In multiple linear regression analysis, adjusted for age, sex, and waist-height ratio, HMW adiponectin levels were associated with Matsuda index (β = 0.5; p = 0.003) and quantitative insulin sensitivity check index (QUICKI) (β = 40.1; p = 0.010) and almost significantly associated with homeostatic model assessment of insulin resistance (HOMA-IR) (p = 0.054). Leptin and resistin levels were not associated with HOMA-IR, Matsuda index, or QUICKI (all p > 0.05). CONCLUSIONS Abnormal glucose metabolism and dysregulation of adipocytokines were common in the HIV-infected adolescents with lipohypertrophy and the combined type. Preventive screening for cardiovascular diseases caused by metabolic alterations should be routinely performed.

中文翻译：

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接受蛋白酶抑制剂的 HIV 感染青少年的脂肪细胞因子失调、葡萄糖代谢异常和脂肪代谢障碍

背景 脂肪代谢障碍在接受蛋白酶抑制剂 (PI)、司他夫定和齐多夫定的 HIV 感染患者中很常见。脂肪细胞因子可能在脂肪营养不良中发生改变。我们评估了具有不同脂肪代谢障碍类型的 HIV 感染青少年的风险因素、脂肪细胞因子水平、胰岛素抵抗和血脂状况。方法 在 80 名围产期 HIV 感染青少年接受基于 PI 的高效抗逆转录病毒治疗≥6 个月的横断面研究。患者接受了口服葡萄糖耐量试验和高分子量 (HMW) 脂联素、瘦素、抵抗素、胰岛素和脂质的测量。他们根据临床表现分为 3 组：无脂肪营养不良、孤立性脂肪萎缩和任何脂肪肥大（孤立性脂肪肥大或联合型）。结果 在 80 名患者中（中位年龄为 16. 7 年），18 人（22.5%）有孤立性脂肪萎缩，8 人（10%）有任何脂肪肥大（4 人为孤立性脂肪肥大，4 人为合并型）。在多变量分析中，长期接触司他夫定（OR：1.03；95% CI，1.01-1.06；p = 0.005）和茚地那韦（OR：1.03；95% CI，1.01-1.06；p = 0.012）与脂肪萎缩相关而长期暴露于去羟肌苷（OR：1.04；95% CI，1.01-1.08；p = 0.017）和茚地那韦（OR：1.10；95% CI，1.00-1.21；p = 0.045）与任何脂肪肥大有关。瘦素水平在任何脂肪肥大组中最高，在孤立脂肪萎缩组中最低（p = 0.013）。HMW 脂联素水平在任何脂肪肥大组中显着最低，在无脂肪营养不良组中最高 (p = 0.001)。三组之间的抵抗素水平没有显着差异（p = 0.234）。胰岛素抵抗 (p = 0.002) 和前驱糖尿病/糖尿病 (p < 0.001) 的患病率在任何脂肪肥大组中显着最高。脂肪萎缩患者和无脂肪营养不良患者的胰岛素抵抗程度相当（p = 0.292）。在多元线性回归分析中，调整了年龄、性别和腰高比后，HMW 脂联素水平与 Matsuda 指数（β = 0.5；p = 0.003）和定量胰岛素敏感性检查指数（QUICKI）（β = 40.1；p = 0.010）并且几乎与胰岛素抵抗的稳态模型评估（HOMA-IR）显着相关（p = 0.054）。瘦素和抵抗素水平与 HOMA-IR、松田指数或 QUICKI 无关（所有 p > 0.05）。结论 糖代谢异常和脂肪细胞因子调节异常在 HIV 感染的脂肪肥大型和混合型青少年中很常见。应定期对由代谢改变引起的心血管疾病进行预防性筛查。