Metabolic problems prior to protease inhibitors

A number of researchers have demonstrated that the lipid changes now being seen in people on HAART were already present to some extent prior to the introduction of effective treatment.¹ For example, high levels of interferon alfa and triglycerides were reported in individuals with AIDS before the introduction of antiretroviral therapy, and significantly slower rates of triglyceride clearance were also evident. Levels of VLDL cholesterol were also elevated in AIDS, and declining HDL cholesterol levels were reported independent of therapy. This pattern is a classic response to infection. Reductions in insulin sensitivity were also noted, but this pattern appears to be unique to HIV infection.

A case of progressive lipodystrophy in the absence of antiretroviral therapy, commencing in 1993, has also been reported, in a woman with persistently undetectable viral load and a high CD4 cell count. The syndrome developed after two years of AZT monotherapy, which was stopped in 1994. The woman developed high triglyceride levels and low HDL cholesterol levels during the period of AZT treatment, in the absence of any other disease which might cause lipid alterations, and in the absence of high alcohol consumption.²