Multiple Subcutaneous Lipomas Induced by HAART in the Absence of Protease Inhibitors

Balestreire, Elena M.; Haught, Justin M.; English, Joseph C.

doi:10.1001/archderm.143.12.1596

Cited by 8 publications

(5 citation statements)

References 3 publications

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“…Google Scholar and Pubmed searches in the English language revealed only 1 other case in which subcutaneous lipomas developed on a regimen without PIs. 4 That patient had been on 3TC, tenofovir and EFV. It is unclear whether EFV, 3TC or both contributed to the lipomas in our case, as that patient was also on both these agents.…”

Section: Discussionmentioning

confidence: 99%

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A rare phenomenon of atypical lipodystrophy in a patient on HAART in the absence of a protease inhibitor regimen

Mitha¹,

Cupido²,

Taljaard³

2010

Southern African Journal of HIV Medicine

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A 45-year-old man, known to be hypertensive and with a history of smoking (5 cigarettes a day for 18 years), presented to Tygerberg Hospital with peripheral vascular disease necessitating bilateral amputations at the knee. The patient had no other significant medical disorders and no previous history of tuberculosis (TB), and consumed alcohol socially. He had been well before this admission, with no previous medical or surgical admissions. The findings on general and systemic examination were normal and no lumps were noted on the body.The patient was tested for HIV as part of his surgical work-up and was found to be positive with a CD4 count of 152 cells/µl. He was commenced on ARVs: stavudine (D4T) 30 mg 12-hourly, lamivudine (3TC) 150 mg 12-hourly and efavirenz (EFV) 600 mg at night. He underwent successful above-knee amputations and was subsequently followed up at the Tygerberg Hospital Infectious Disease Clinic approximately 1 month later.The patient was doing well and reported no problems or side-effects from the ARVs. The stumps were clean and findings on a thorough physical examination were normal. No lumps were detected on the patient's body at this visit. The patient had no symptoms of TB, but a chest radiograph revealed infiltrates in the right upper zone. At this stage we were still awaiting sputum results from his initial admission. Two weeks later (approximately 6 weeks after ARV initiation) drugsusceptible TB was diagnosed on sputum culture. TB treatment was immediately commenced.The patient returned for a follow-up visit after a further 2 weeks complaining of multiple lumps on the trunk and abdomen. Physical examination revealed multiple soft, mobile, non-tender nodules on the abdomen (Fig. 1), measuring approximately 2×2 cm. A fine-needle aspirate and excision biopsy confirmed that these were lipomas. A fasting lipogram revealed a total cholesterol level of 5.7 mmol/l, a triglyceride level of 2.0 mmol/l, a high-density lipoprotein (HDL) cholesterol level of 1.2 mmol/l and a low-density lipoprotein (LDL) cholesterol level of 3.6 mmol/l.The patient was counselled regarding his condition and continued on his anti-TB treatment and ARVs. He was started on the appropriate medical management for his dyslipidaemia and given appropriate dietary advice. A RARE PHENOMENON OF ATYPICAL LIPODYSTROPHY IN A PATIENT ON HAART IN THE ABSENCE OF A PROTEASE INHIBITOR REGIMEN C A S E S T U DY 37Lipodystrophy is a complication of patients on antiretroviral (ARV) medication; however, it is commonest in patients on long-term treatment and those on protease inhibitor (PI) regimens. 1,2 We present a rare case of atypical lipodystrophy, presenting as multiple subcutaneous lipomas, in a patient who had been on a non-PI ARV regimen for 6 weeks.

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Section: Discussionmentioning

confidence: 99%

“…4,5 Owing to the unique nature of our case, with no evidence base to guide treatment, it was decided to continue the regimen of 3TC, D4T and EFV.…”

Section: Discussionmentioning

confidence: 99%

A rare phenomenon of atypical lipodystrophy in a patient on HAART in the absence of a protease inhibitor regimen

Mitha¹,

Cupido²,

Taljaard³

2010

Southern African Journal of HIV Medicine

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“…This was associated in all the cases with a rise in at least one count of serum low‐density lipoprotein, triglycerides or total cholesterol 5 . More rarely, multiple lipomas have been reported in patients taking HAART 6 …”

Section: Human Immunodeficiency Virus Lipodystrophy Syndromementioning

confidence: 90%

“…5 More rarely, multiple lipomas have been reported in patients taking HAART. 6 The fat accumulation is related to older age at starting treatment, higher body mass index, lower CD4 count at the start of treatment, and use of PIs for treatment. 2 Current therapeutic strategies for lipoatrophy, including changing medications, are relatively ineffective.…”

Section: Human Immunodeficiency Virus Lipodystrophy Syndromementioning

confidence: 99%

Dermatological aspects of medicine: highly active antiretroviral therapy and the treatment of human immunodeficiency virus

Finucane

Archer

2010

Clinical and Experimental Dermatology

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This is the sixth in a series of CPD articles aimed at reviewing the recent general medical literature relating to topics that may be of interest to dermatologists. In this issue the new classes of anti-retroviral drugs will be described in the context of the replication cycle of human immunodeficiency virus (HIV). The regimens of drug treatments and the more common side-effects including HIV-lipodystrophy syndrome will be discussed along with the recommendations for testing of people for HIV from new guidelines.

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“…In our patient there was no antecedent trauma which may have caused localized nodular fat necrosis or fasciitis. Multiple subcutaneous lipomas induced by antiretroviral drugs have been reported [ 6 ]. More recently, leiomyosarcoma due to Epstein-Barr Virus (EBV) infection has emerged as a malignant soft tissue tumor that may arise in setting of HIV infection [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Kaposi sarcoma of the subcutaneous tissue

2008

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Multiple Subcutaneous Lipomas Induced by HAART in the Absence of Protease Inhibitors

Cited by 8 publications

References 3 publications

A rare phenomenon of atypical lipodystrophy in a patient on HAART in the absence of a protease inhibitor regimen

A rare phenomenon of atypical lipodystrophy in a patient on HAART in the absence of a protease inhibitor regimen

Dermatological aspects of medicine: highly active antiretroviral therapy and the treatment of human immunodeficiency virus

Primary Kaposi sarcoma of the subcutaneous tissue

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