Indinavir-associated lipodystrophy

Lipodystrophies are rare cutaneous disorders characterized by the symmetrical loss of subcutaneous fat from the body surface. The cause of lipodystrophy is not known, but a possible genetic predisposition is likely and either overt diabetes mellitus or insulin resistance are often associated.

Case study.

Eight patients who developed either partial or generalized lipodystrophy after protease inhibitor therapy.

In all eight patients lipodystrophy occurred after 2-12 months of starting indinavir and was not preceded by weight loss or inflammatory skin disease. Short-term follow-up after withdrawal of therapy showed no change in the patients' appearance. One patient developed glycosuria as lipodystrophy became manifest. In three cases glucose tolerance test was performed revealing a high level of insulin between the first and third hour of loading.

In our view, lipodystrophy is an unwanted side-effect of protease inhibitor therapy causing noticeable disfigurement.