In this Mestizo Peruvian population, prevalence of the MS is relatively low as compared to other ethnic groups; the higher prevalence in females is likely due to a higher prevalence of abdominal obesity. Overall, abdominal obesity and hypertriglyceridemia were the predominant combination of metabolic disorders in individuals fulfilling criteria for the diagnosis of the MS.
The roles of nucleoside analogues and protease inhibitors (PIs) in the development of metabolic complications and fat-distribution abnormalities associated with highly active antiretroviral therapy (HAART) are not well known. We performed an observational study in which efavirenz was substituted for a PI for 41 patients receiving HAART who had prolonged virus suppression, clinical signs of severe lipoatrophy, hyperlipidemia, and insulin resistance. Clinical follow-up was performed for 1 year. Virus suppression was maintained in most of the patients, and a significant increase in CD4(+) lymphocyte count was observed, but no change in lipid profile or insulin resistance was observed. Abdominal fat content did not change, and subcutaneous fat depletion was even more pronounced >1 year after the switch. We conclude that, for PI-treated patients who present with lipoatrophy, hyperlipidemia, and insulin resistance, substituting efavirenz for PIs can maintain virus suppression and immunologic response to HAART, but it does not improve the lipid profile or resolve insulin resistance or lipoatrophy.
Our results suggest that the glutamic acid 27 allele of the beta2-adrenoceptor may be a risk factor in men but not in women for the accumulation of visceral fat and for its association with the development of type 2 diabetes mellitus.
On page 791, in the second column, the second full sentence should begin, "Camurati-Engelmann syndrome, a bone overgrowth defect due to TGFB1 missense mutations...".
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