German doctors, writing in the April 2003 edition of AIDS report what is thought to be the first case of an HIV-negative man developing central adiposity (fat accumulation) after taking HIV post-exposure prophylaxis (PEP).
The case concerned a 32 year old man who was given two courses of PEP after repeated high risk sex with his HIV-positive partner. PEP consisted of two three-week courses of 300mg efavirenz twice daily, with 40mg of d4t and 150mg of 3TC, both twice daily. The man remained HIV-negative at least four months after the last exposure.
Despite maintaining his usual diet and patterns of physical activity, within six weeks of the second course of PEP the man developed a rapid increase in abdominal girth, with associated bloating and loss of appetite. The doctors describe his body change as resembling “protease paunch”, an indicator of lipodystrophy. However the man’s blood lipids remained normal. Nor did he develop the fat loss which is also seen in people with lipodystrophy. Striking before and after photographs taken between the two courses of PEP, and again eight weeks after the second course of PEP, demonstrate substantial abdominal distention. The fat accumulation persisted for at least four months after the last exposure to antiretrovirals.
Dr Stefan Mauss and colleagues believe that the case casts some light on the causes of lipodystrophy and suggest that “this case report may be a limited proof of principle that the alterations in adipose tissue are caused by antiretroviral combination therapy rather than HIV infection itself.” They conclude that patients receiving PEP should be assessed for evidence of lipodystrophy.
Further information on this website
Post exposure prophylaxis (PEP)
Body fat changes on HAART (lipodystrophy) - overview
Mauss S et al. Rapid development of central adiposity after postexposure prophylaxis with antiretroviral drugs: a proof of principle? AIDS 17: 944 – 955, 2003.