Endocrine Abstracts

Introduction: The use of highly active antiretroviral therapy in 1996 helped greatly reduce the morbidity and mortality in patients infected by HIV. Very quickly, secondary metabolic complications to this same treatment have been described. Dyslipidemia occupy a large part of these complications and give the patients an atherogenic profile favouring the occurrence of acute coronary events. We report a case that illustrates the lipid abnormalities associated with anti retroviral treatment.

Case report: The subject was 54 years old woman, diabetic for 8 years, without history of hypertension or smoking, BMI was 29 Kg/m², diagnosed as HIV infected for 1 year, treated by antiretroviral therapy. Her initial lipid profile reveals a moderate hypertriglyceridemia of 2.5 g/l, total cholesterol was 1.7 g/l and HDL cholesterol was 0.3 g/l. High plasma viral loads persisted after 6 months of antiretroviral therapy, thus the patient was considered to have a treatment failure. The control of her lipid profil, after 2 months of a second-line combination therapy, reveals an aggravation of her previous dyslipidemia with a severe hypertriglyceridemia of 6.36 g/l, an hypercholesterolemia of 2.72 g/l and HDL cholesterol was 0.4 g/l.

Discussion: While the retroviral infection itself, especially at the AIDS stage, is responsible for an increase in triglycerides and a decrease in total cholesterol, antiretroviral therapy exacerbates abnormal lipid metabolism. This is mainly dyslipidemia with predominant hypertriglyceridemia, associated with an increase in total cholesterol and LDL-cholesterol; HDL-cholesterol is either lowered or slightly modified, these abnormalities are partly due to increased hepatic synthesis of large VLDL and decreased purification of remnants rich in triglycerids. The Knowledge of lipid abnormalities induced by antiretroviral treatment is critical for better patient management between infectiologist, biologist and endocrinologist.