Fat accumulation at the front of the neck can be added to the list of body shape abnormalities caused by HAART, say Australian investigators.
In the August 15th edition of AIDS doctors from Victoria report the case of a 35-year old man who developed fat accumulation at the front and back of his neck after taking a HAART regimen containing lopinavir/ritonavir. The man was diagnosed HIV-positive in 1989 and had previously been treated with AZT monotherapy, followed by a HAART regimen consisting of AZT, 3TC and saquinavir in 1996, which was replaced with d4T, ddI, indinavir and ritonavir in 2000.
The development of kidney problems led to indinavir being replaced with lopinavir in 2001.
Hair loss in the legs was also observed by the patient when he started taking lopinavir/ritonavir, and examination revealed that the man also had a buffalo hump, wasting of fat from the face, limbs and buttocks, and had high blood pressure.
Replacement of lopinavir with the NNRTI nevirapine failed to stop the neck swelling, which was uncomfortable and restricted movement. A CT scan showed fat accumulation at the front of the neck. Blood tests revealed that the man had a CD4 cell count of 350 cells/mm3 and an undetectable viral load. His fasting cholesterol was 5.9mmol/L and triglycerides were 6.7mmol/L.
The patient’s comfort and movement improved markedly following the removal of the fat deposit at the front of the neck by liposuction.
The investigators report that they have also seen at least three other similar cases, each involving fat accumulation at the front and back of the neck and fat wasting from the face, limbs and buttocks. However, there was no consistency in the HAART regimens used by these individuals. One patient had never taken a protease inhibitor and developed body fat changes after taking 3TC, d4T and nevirapine. The other two patients were taking protease inhibitor - containing regimens with one taking ddI, 3TC, AZT, and the other lopinavir/ritonavir and 3TC, AZT, indinavir, ritonavir and nevirapine. All three had taken earlier anti-HIV regimens and also had lipid abnormalities.
It is unlikely, conclude the investigators, that treatment factors alone explain this newly observed manifestation of lipodystrophy, and suggest that “it is probable that host factors play a significant role”, adding a call for further research at a clinical and basic science level.
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Woolley IJ et al. Anterior neck fat deposition in lipodystrophy syndrome; a new variant on a theme?. AIDS 17, 1857 – 8, 2003.