754 Serum Adipocytokines are Related to Lipodystrophy and Metabolic Alterations in HIV-infected Men Under PI-Based HAART C. Vigouroux1,2, M. Maachi1,2, T-H. Nguyen1, C. Coussieu3, S. Gharakhanian1, T. Funahashi4, Y. Matsuzawa4, I. Shimomura4, W. Rozenbaum1, J. Capeau*1,2, J-P. Bastard1,2 1Tenon Hosp, Paris, France; 2INSERM U 402, Paris, France; 3Hôtel-Dieu Hosp, Paris, France; and 4Osaka Univ, Japan
Background: Adipocytokines, secreted by adipose tissue, may regulate fat metabolism, lipid, and glucose homeostasis and insulin sensitivity. We analyzed the relations between circulating concentrations of adiponectin, leptin, interleukin-6, tumor-necrosis-factor a and its soluble receptors sTNFR1 and R2, lipodystrophic phenotypes and metabolic alterations in patients (pts) under HAART.
Methods: We studied 131 consecutive HIV-infected males under PI-based HAART, with body mass index < 27 kg/m2 and C-reactive protein (CRP) < 10 mg/l. Pts were classified in four groups according to clinical examination: no lipodystrophy (NL), lipohypertrophy (LH), lipoatrophy (LA) and mixed lipodystrophy (ML). In addition to adipocytokines, we measured plasma fasting levels of triglycerides, cholesterol, cardiovascular risk markers (high-sensitivity CRP and apolipoproteins B/A1 ratio), fasted and 2h-post glucose loading glycemia and insulinemia and calculated the quantitative insulin sensitivity check index.
Results: The pts were HIV-infected and PI-treated for a mean of 8.2 and 1.6 yrs, respectively; 74% presented lipodystrophy, 38% altered glucose tolerance and 42% hypertriglyceridemia. Insulin sensitivity correlated positively with adiponectin and negatively with leptin and interleukin-6. Adiponectin, but not leptin, negatively correlated with all metabolic parameters. Insulin resistance, metabolic defects and cardiovascular risk markers were strongly negatively correlated with the adiponectin/leptin ratio (A/L), and positively with sTNFR1. LA pts had a longer duration of infection but ML pts presented the most severe metabolic alterations, insulin resistance and A/L decrease.
Conclusions: These results suggest that adiponectin and the TNFa system are related to lipodystrophy, insulin resistance and metabolic alterations in pts under PI-based HAART. A/L and sTNFR1 could predict insulin sensitivity and potential cardiovascular risk in these pts.
