Abstract
BACKGROUND: The HIV-associated lipodystrophy syndrome may present as fat accumulation and/or fat loss with metabolic abnormalities such as hyperlipidaemia and insulin resistance. Although initial reports described an association between protease inhibitor (PI) therapy and lipodystrophy, recent studies have shown NRTIs also play a role, primarily in subcutaneous fat wasting. Raised lactate levels have also been described in patients taking antiretroviral therapy, rarely decompensated leading to symptomatic lactic acidosis.
OBJECTIVES: In this analysis we report the prevalence of subcutaneous fat wasting and raised lactate levels and investigate the utility of lactate monitoring in the investigation of patients at risk of subcutaneous fat wasting.
DESIGN: Publicly available data were collected from studies that reported lipodystrophy and/or raised lactate levels with antiretroviral therapy. The relationship between elevated lactate and subcutaneous fat wasting was evaluated using longitudinal data from the Western Australia HIV Cohort Study.
RESULTS: Mild elevations in lactate levels were observed in ~20% of treated patients across studies. In patients from the Western Australia HIV Cohort Study, a lactate level > 1.8 μmol/l was associated with a significantly shorter time to subcutaneous fat wasting assessed by DEXA (P=0.015). Cox proportional hazards modelling also showed an effect of raised lactate for the development of subcutaneous fat wasting.
CONCLUSION: Although decompensated lactic acidosis is rare, compensated elevations in plasma lactate are common and may help predict patients at risk for the development of subcutaneous fat wasting.