648   Does Race Protect an Oriental Population from Developing Lipodystrophy in HIV-Infected Individuals on HAART?

K. Chang*, J. Kim, S. Hong, Y. Song, H. Lee, and S. Lim.
Yonsei Univ. Coll. of Med., Seoul, South Korea.

Background:Lipodystrophy, hyperlipidemia and hyperinsulinemia are common metabolic complications of highly active antiretroviral therapy (HAART) in human immunodeficiency virus (HIV)-infected Caucasians. We questioned if such complications also exist in other races.

Methods:Cross-sectional analysis was done in an outpatient clinic of a university teaching hospital. 122 Koreans were divided into 3 groups: HIV-infected subjects receiving double nucleoside reverse transcriptase inhibitors and one protease inhibitor (PI) (n = 45, group 1), HIV-infected HAART-naive subjects (n = 32, group 2), and healthy controls (n = 45, group 3). Lipodystrophy was assessed by physical examination, questionnaire, and body composition by dual-energy X-ray absorptiometry (DEXA). Fasting triglyceride (TG), total cholesterol, LDL and HDL cholesterol, free fatty acid, apolipoprotein (Apo) A1, Apo B, glucose, insulin, c- peptide, leptin, cortisol, dehydroepiandrosterone (DHEA), CD4, CD8 lymphocyte counts and HIV RNA load were measured. Continuous variables were analysed by analysis of variance (ANOVA) methods and multiple comparison analysis (LSD) of the SAS system.

Results:The most distinctive difference of the adverse effects of HAART in this study with Koreans is that lipodystrophy was not observed in any subjects at all. Regional and total fat loss is not seen, and there is no difference in the trunk to appendicular fat ratio between HAART-experienced and -naive individuals and controls measured by DEXA. No difference in TG and HDL cholesterol was observed between HAART-experienced and -naive individuals, but TG concentration was increased (mean 190.3 vs. 107.3 mg/dl; p < 0.05) and HDL cholesterol was decreased (mean 30.7 vs. 43.4 mg/dl; p < 0.05) in HAART-experienced individuals when compared to controls. Basal insulin (mean 15.7 vs. 5.2mIU/ml), c-peptide (mean 3.7 vs. 1.4 ng/ml) and insulin resistance (mean 4.1 vs. 1.3 mmol²/l²) were significantly higher in group 1 compared to group 3 (p < 0.05).

Conclusions:Loss of total and peripheral fat mass is a common complication of HAART in Caucasians but does not seem to be manifested in HIV-infected Koreans. These findings warrant further race-specific metabolic complication studies in HIV-infected subjects submitted to HAART.