Abstract 928
The lipodystrophy induced by HIV protease inhibitors is increasingly recognized in adults with HIV disease during protease inhibitor therapy. It has been characterized by central adipose deposition with peripheral muscle wasting, buccal fat pads, cervical fat pads ("buffalo humps"), hypertriglyceridemia, or hypercholesterolemia. The etiology of this disorder is unknown. We report the development of findings similar to those found in adults with lipodystrophy in a 4-year-old perinatally infected male. His previous antiretroviral history included zidovudine, didanosine, and a brief trial of ritonavir from August 1996 to January 1997, which was discontinued due to onset of pneumatosis intestinalis. He initiated new antiretroviral therapy in April 1997 with stavudine, nevirapine, and nelfinavir. Random triglyceride levels prior to April 1997 were 121 mg/dl (normals 34-122). At the time, HIV RNA was 125,000 copies/ml and did not demonstrate any significant decline over the next year. CD4 percentage remained 2-3%, and absolute CD4 numbers were 30-50 cells/µl over 12 months. His exam was significant for progressively increasing abdominal girth and peripheral muscle wasting. Between April 1997 and April 1998, random triglyceride levels ranged between 122 and 296 mg/dl. By April 1998, a weight gain of only 1 lb. was noted despite receiving high calorie formula overnight via gastrostomy tube. An abdominal CT scan performed at this time because of recurrent pneumatosis intestinalis demonstrated a large amount of mesenteric fat. His antiretroviral therapy was changed to zidovudine, lamivudine, ritonavir, indinavir, and saquinavir in May 1998. His viral load subsequently declined and was < 100 copies/ml 4 months after this change in therapy. While his viral load has remained undetectable for three months, his random triglyceride levels remain elevated between 214 and 569 mg/dl. He has gained 5 lbs. in the past six months. Incidental CT of the abdomen 6 months after this change in therapy demonstrates less mesenteric fat.
