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"HAART increased fasting
insulin levels and the LDL:HDL ratio in female patients."
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Lipodystrophy And Leptin
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In
another small study, metabolic side effects of HAART including increased
triglycerides, leptin, and low-density lipoprotein (LDL) cholesterol were
more pronounced in women than in men. (10)
HAART increased fasting insulin levels and the LDL:HDL ratio in female
patients. Estrada and colleagues described significantly lower plasma leptin
levels in 34 HIV-infected lipoatrophic patients compared to 398 healthy
study participants.
(8) Investigators
noted that of the lipodystrophy patients, 5.8% were diabetic and 17.8%
had impaired glucose tolerance. Besides low plasma leptin levels, peripheral
fat loss in extremities was associated with visceral fat accumulation and
metabolic disturbances that increased the risk of cardiovascular disease.
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A study of 20 HIV-positive
children revealed a link among CD4+ T-cells and serum leptin levels, which
increased after HAART. (6) HAART significantly
increased CD4+ T-cells and serum leptin in most of the children. Initiation
of HAART, however did not increase CD4+ lymphocyte counts or serum leptin
in some of the children.
As more HIV-positive people
experience adverse metabolic complications from using HAART, methods to
deal with these side effects will become increasingly important. Leptin
therapy appears promising so perhaps future studies will continue to assess
the value of this hormone for HIV-positive individuals with lipodystrophy.
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References
1.
Oral EA, Simha V, Ruiz E, et al. Leptin-replacement therapy for lipodystrophy.
N Engl J Med 2002;346(8):570-8.
2.
Treatment for lipodystrophy reveals new workings of leptin. WIN
Notes Fall 2002, page 5. Weight-control Information Network, Bethesda,
MD.
3.
Méndez-Sánchez N, González V, King-Martínez
AC, et al. Plasma leptin and the cholesterol saturation of bile are correlated
in obese women after weight loss. J
Nutr 2002;132:2195-2198.
4.
Mark AL, Correia ML, Rahmouni K, Haynes WG. Selective leptin resistance:
a new concept in leptin physiology with cardiovascular implications. J
Hypertens 2002;20(7):1245-1250.
5.
Gomez-Ambrosi J, Salvador J, Paramo JA, et al. Involvement of leptin in
the association between percentage of body fat and cardiovascular risk
factors. Clin
Biochem 2002;35(4):315-20.
6.
Matarese G, Castelli-Gattinara G, Cancrini C, et al. Serum leptin and CD4+
T lymphocytes in HIV+ children during highly active antiretroviral therapy.
Clin Endocrinol (Oxf). 2002;57(5):643-6. Available through http://www.blackwell-synergy.com/.
7.
Warren MP, Ramos RH, Bronson EM. Exercise-associated amenorrhea Are altered
leptin levels an early warning sign?
Phys Sportsmed 2002;30(10).
8.
Estrada V, Serrano-Rios M, Martinez Larrad MT, et al. Leptin and adipose
tissue maldistribution in HIV-infected male patients with predominant fat
loss treated with antiretroviral therapy. J
Acquir Immune Defic Syndr 2002;29(1):32-40.
9.
Mynarcik DC, Combs T, McNurlan MA, Scherer PE, et al. Adiponectin and leptin
levels in HIV-infected subjects with insulin resistance and body fat redistribution.
J Acquir Immune Defic Syndr 2002;31(5):514-20.
10.
Pernerstorfer -Schoen H, Jilma B, Perschler A, Wichlas S, et al. Sex differences
in HAART-associated dyslipidaemia. AIDS
2001;15(6):725-34.
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