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- W2054333772 abstract "Early start of antiretroviral combination therapy in patients with HIV-1 infection has been recommended to achieve long-term viral suppression and immune reconstitution[1]. Metabolic abnormalities such as hypertriglyceridaemia, hypercholesterinaemia, insulin resistance and subcutaneous fat wasting with the use of stavudine and visceral fat accumulation with the use of protease inhibitors (PI) have been described by various authors[2, 3]. This is the first report about an HIV-1 infected patient who developed a lipodystropy associated with zidovudine, lamivudine and efavirenz without any prior antiretroviral treatment. Twenty-two months after starting his first antiretroviral regimen, the 44-year-old, African-American male patient complained about an increase in abdominal girth, fullness and heartburn. The patient denied increased caloric intake or reduced physical activity since the introduction of the antiretrovirals. The physical examination showed an enlarged abdomen and diastasis recti. There was no loss of subcutaneous fat. His body mass index (BMI) was unchanged compared to baseline (25.2 kg/m2). Abdominal CT scan showed visceral abdominal fat accumulation with a visceral to total adipose tissue ratio (VAT/TAT) of 0.44 (normal value 0.4)[4]. Lipid and glycaemic measurements were in the normal range. To date, 33 months after treatment initiation, the abdominal girth has increased further ( Fig. 1), the clinical symptoms have worsened and the BMI has increased to 27.0 (kg/m2). Oral glucose tolerance test shows insulin resistance. Cholesterol and triglycerides are in the normal range. Patient with increased abdominal girth. The patient's HIV-1 infection was known 4 years prior to the start of treatment. At the time of treatment initiation he was asymptomatic. Baseline CD4 count was 836 cells/μL and viral load was 56 000 copies/mL. Soon after starting antiretrovirals, the viral load fell below the limit of detection in the ultrasensitive assay and remained undetectable. The CD4 count increased continuously up to 1384 cells/μL. It appears, from our case, that lipodystrophy is not only restricted to the use of PI or stavudine-containing regimens and that the immunological and virological benefit associated with the early start of antiretroviral treatment may be limited due to toxicities of the current drugs." @default.
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- W2054333772 date "2000-07-01" @default.
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- W2054333772 title "A case of lipodystrophy after the initiation of zidovudine, lamivudine and efavirenz in an asymptomatic HIV-1-infected patient" @default.
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- W2054333772 doi "https://doi.org/10.1046/j.1468-1293.2000.00021.x" @default.
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