Objective: The measurement of phase angles is an important monitoring parameter and supplementation with omega-3 could promote benefits by modulating the electrical potential of membranes and increasing body cell mass...Objective: The measurement of phase angles is an important monitoring parameter and supplementation with omega-3 could promote benefits by modulating the electrical potential of membranes and increasing body cell mass. This study aimed to evaluate the effectiveness of omega-3 fatty acid supplementation on the phase angle of people living with HIV/AIDS. Methods: In this study, 63 individuals of all genders who were undergoing outpatient follow-up and showed lipodystrophy due to highly active antiretroviral therapy were analyzed. Our sample consisted of two groups, one that received supplementation containing 2550 mg of omega-3/day (1080 mg of eicosapentaenoic acid and 720 mg of docosahexaenoic acid) for three months (n = 32) and another that underwent nutrition guidance (n = 31). Phase angle and body cell mass were assessed for both groups and compared at the beginning of research (T0) and after our intervention (T1) for each group separately. Results: Phase angle averaged 6.45° ± 1.06 SD. The comparison between T0 and T1 showed a significant increase in phase angle and body cell mass, whereas the guidance group showed a decrease in body cell mass at T1 in relation to T0, with a significant p-value. Variance in phase angle between moments showed significant values between T0 and T1 in the supplementation group for all genders. Conclusion: Omega-3 positively modulated patients phase angle and body cell mass, but we emphasize the need for other studies that can solidify knowledge about supplementation dosage and intervention time.展开更多
BACKGROUND Latent autoimmune diabetes in adults(LADA)is a special type of type 1 diabetes mellitus.During the early stages,patients with LADA are treated with oral antidiabetics.However,insulin treatment is still requ...BACKGROUND Latent autoimmune diabetes in adults(LADA)is a special type of type 1 diabetes mellitus.During the early stages,patients with LADA are treated with oral antidiabetics.However,insulin treatment is still required as islet function gradually declines.Once patients have developed insulin allergy,clinical treatment and nursing care become very challenging.CASE SUMMARY Here,we report a case of LADA with insulin-related lipodystrophy,allergy,and exogenous insulin autoimmune syndrome during insulin treatment,thus making it very difficult to effectively control glucose levels with insulin.We attempted subcutaneous injection and an insulin pump to desensitize the patient’s response to insulin,and finally assisted the doctor to select the appropriate insulin treatment for the patient.We describe the management of this patient from a nursing viewpoint.CONCLUSION We summarize the nursing experience of a case with complex insulin allergy requiring desensitization treatment.Our approach is very practical and can be applied to similar patients needing insulin desensitization.展开更多
The occurrence of lipodystrophy in patients taking antihuman immunodeficiency virus(HIV) medications is a serious problem as it is irreversible even after drug withdrawal. Although it was first recognized in patients ...The occurrence of lipodystrophy in patients taking antihuman immunodeficiency virus(HIV) medications is a serious problem as it is irreversible even after drug withdrawal. Although it was first recognized in patients taking proteinase inhibitors, other types of anti-HIV agents can also cause lipodystrophy. In a recent publication by Jones et al entitled "Highly active antiretroviral therapy dysregulates proliferation and differentiation of human pre-adipocytes" in World Journal of Virology, it was reported that simultaneous treatment of human subcutaneous adipocytes with anti-HIV drugs with different mechanisms of action synergistically exerted antiadipogenesis effects in vitro, warning us to take utmost care in every case receiving combination antiretroviral therapy(cART). For elucidation of the molecular basis for cART-related lipodystrophy, multi-faceted approaches should be taken, based on a deeper understanding of the development and organization of adipose tissues.展开更多
Dunnigan-type partial lipodystrophy, which is characterized by a number of metabolic alterations, change in body fat distribution, and autosomal dominant inheritance pattern, is rare in the general population. Objecti...Dunnigan-type partial lipodystrophy, which is characterized by a number of metabolic alterations, change in body fat distribution, and autosomal dominant inheritance pattern, is rare in the general population. Objective: To report the case of an adolescent with clinical and laboratory findings suggestive of Dunnigan-type partial lipodystrophy. Methods: Case report and literature review. Results: A 15-year-old adolescent presented at the clinic complaining of darkening of skin folds on her trunk and back. During physical examination, the presence of serious acanthosis nigricans in her cervical region, axillae, and intergluteal space was noted. Hirsutism in androgen-dependent areas was also observed, as well as relevant reduction of subcutaneous adipose tissue in the limbs, gluteal region, abdomen, and trunk and fat accumulation in the face and chin. Discussion. Dunnigan-type familial partial lipodystrophy is a rare dominant autosomal disease resulting from a heterozygous missense mutation in the LMNA gene, known as LPF type 2 (Dunnigan variant), which encodes the nuclear protein A/C-type lamin. It is characterized by the progressive disappearance of the subcutaneous adipose tissue in the limbs, gluteal region, abdomen, and trunk, with onset in puberty, followed by fat accumulation in other areas such as the face, chin, labia majora, and intra-abdominal region, leading to hypertrophy that may mimic the Cushing’s syndrome phenotype. Affected patients display marked insulin resistance and may consequently develop diabetes mellitus, acanthosis nigricans, hirsutism, and polycystic ovary syndrome. Conclusion: This case report highlights the importance of suspecting Dunnigan-type familial partial lipodystrophy in clinical practice. Early clinical diagnosis allows for measures that minimize the severe metabolic disorders associated with this disease and, consequently, these adolescents’ self-esteem issues.展开更多
Congenital lipodystrophy is a group of rare syndrome characterized by the absence of subcutaneous tissue. Affecting less per million live birth, this condition associate metabolic disturbance including severe insulin ...Congenital lipodystrophy is a group of rare syndrome characterized by the absence of subcutaneous tissue. Affecting less per million live birth, this condition associate metabolic disturbance including severe insulin resistance and progeroid appearance. Diagnosis may be fortuitous or related to complications as presented in the present case series. Lipodystrophy can be generalized or localized. Acquired lipodystrophy is associated with some drugs like antiretroviral. Thus, the condition is well described in African HIV patients but data on congenital forms from Sub Saharan Africa are sparse, justifying the present report. We present four cases, with peculiar appearance associated with increased blood triglycerides. Two on four of the patients presented diabetes mellitus. Genetic testing was not available, questioning the actual guidelines of diagnosis for our context.展开更多
A subset of HIV-1 infected patients undergoing antiretroviral treatment with HIV-1 protease inhibitors (PI’s) develops a syndrome called Lipodystrophy of HIV (LDHIV). LDHIV is characterized by loss of peripheral subc...A subset of HIV-1 infected patients undergoing antiretroviral treatment with HIV-1 protease inhibitors (PI’s) develops a syndrome called Lipodystrophy of HIV (LDHIV). LDHIV is characterized by loss of peripheral subcutaneous adipose tissue (face, limbs, buttocks), visceral fat accumulation, and in some cases, lipomatosis in the neck and dorsocervical area .We describe the clinical and imaging features of LDHIV in the head and neck in a series of 5 cases. There is a consistent pattern of fat accumulation in the dorsocervical region with paucity of fat in the face. This classic appearance should be recognized as potentially related to drug toxicity in the HIV infected population.展开更多
Currently, with the increase in life expectancy of people living with HIV (PLHIV), it is essential to analyze the biopsychosocial aspects involved in satisfaction with quality of life and its multidimensionality, beca...Currently, with the increase in life expectancy of people living with HIV (PLHIV), it is essential to analyze the biopsychosocial aspects involved in satisfaction with quality of life and its multidimensionality, because although HAART produces hope for the control of HIV, can have important emotional consequences. Thus, the aim of the present study was to evaluate the effects of lipodystrophy (LDS) on self-esteem and body image of PLHIV in Brazil. It is a psychoanalytic method by semi-structured interview, a body image scale and two drawings that represent the patients’ body image before and after. The diagnosis of LDS was by self-report. Sixteen patients 8 (eight men and 8 women), with a mean age of 43 years, were invited to the HIV-Out ADEE 3002 outpatient clinic of the Dermatology Clinic of the Central Institute of a University Hospital in São Paulo. It was noted that 50% of patients reported physical problems and 25% consequences in the family and social sphere. There were increased bodily changes, family problems and social prejudices after HAART and the self-esteem of 88% of patients were shown to be “little adjusted” to their condition. For 63%, physical appearance was a concern and 87% of them reported body dissatisfaction. Patients also reported impact on their sexuality (75% felt less attractive and 88% with reduced libido after starting LDS). The interviews, drawings and body image scale showed important changes in the lives of patients with lipodystrophy, where negative changes in appearance and effects on self-image were observed. This diagnosis seems to influence other aspects of social life, which can lead to prejudice in relation to illness and, therefore, isolation.展开更多
Management of Human Immunodeficiency Virus infection remains a major challenge in many sub-Saharan African countries. Antiretroviral drugs which have reduced significantly the mortality rate of this pandemic disease a...Management of Human Immunodeficiency Virus infection remains a major challenge in many sub-Saharan African countries. Antiretroviral drugs which have reduced significantly the mortality rate of this pandemic disease are a source of side effects. Among these side effects, adult lipodystrophy has already been described by several authors. The aim of this study is to determine the prevalence of lipodystrophy and associate factors in children on antiretroviral therapy, managed at Charles De Gaulle Children University Hospital and Yalgado Ouedrago University Hospital in Ouagadougou, Burkina Faso. This is a cross-sectional study conducted from June 2013 to January 2014. We included children aged 2 to 15 years who had been on antiretroviral treatment for at least six months with no severe acute malnutrition (wasting). Lipodystrophy was diagnosed clinically after assessment of morphological changes. Overall, 323 children complying with the inclusion criteria were examined. The average duration of antiretroviral therapy was 5.3 years. Forty five children had lipodystrophy, i.e. 13.9% prevalence rate. One hundred and twenty seven different lipodystrophic lesions were noted, hence 82.7% lipoatrophy and 17.3% lipohypertrophy. The most common presentations were: face (32%), lower limbs (26%) and upper limbs (15.7%). Factors associated with lipoatrophy were: age above 10 years (P = 0.004);male gender (P = 0.0004);antiretroviral treatment duration of more than 60 months (P < 0.001) and treatment with stavudine (P = 0.01). Our study showed that lipodystrophy is not exceptional in children on antiretroviral therapy in Ouagadougou. However, more researches on lipid profiles of these children are necessary to prevent other common complications related to fat accumulation.展开更多
Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological pheno...Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves’ disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves’ disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient developed Graves’ disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.展开更多
AIM To investigate the mechanism(s) by which potential effects of multi-drug highly-active antiretroviral therapy contributes to lipodystrophy syndrome. METHODS Preadipocytes from healthy donors were assessed for prol...AIM To investigate the mechanism(s) by which potential effects of multi-drug highly-active antiretroviral therapy contributes to lipodystrophy syndrome. METHODS Preadipocytes from healthy donors were assessed for proliferation and differentiation in the presence of nucleoside reverse transcriptase inhibitors(NRTIs), nonnucleoside reverse transcriptase inhibitors(NNRTIs), and protease inhibitors(PIs) individually and in combination. Effects on proliferation were assessed with a 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide assay and effects on differentiation were assessed from glycerol-3-phosphate dehydrogenase(GPDH) activity and quantitation of Oil Red O staining for intracellular lipid. Data were analyzed with a randomized block ANOVA with post-hoc Fisher's Least Significant Difference test. RESULTS Preadipocyte proliferation was inhibited by a combination of NNRTI + NRTI(14% at 48 h, P < 0.001) and PI + NRTI(19% at 48 h, P < 0.001) with additional suppression when ritonavir(RTV) was added(26% at 48 h). The drug combination of atazanavir(ATV) + RTV + emtricitabine(FTC) + tenofovir(TDF) had the greatest inhibitory effect on proliferation at 48 h. Preadipocyte differentiation was most significantly reduced by the efavirenz + FTC + TDF assessed either by GPDH activity(64%) or lipid accumulation(39%), P < 0.001. Combining NRTIs with a PI(ATV + FTC + TDF) significantly suppressed differentiation(GPDH activity reduced 29%, lipid accumulation reduced by 19%, P < 0.01). This effect was slightly greater when a boosting amount of RTV was added(ATV + FTC + TDF + RTV, P < 0.001). CONCLUSION Although combination antiretroviral therapy is clinically more efficacious than single drug regimens, it also has a much greater inhibitory effect on preadipocyte proliferation and differentiation.展开更多
The introduction of highly active antiretroviral therapy(HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome.In developed countries,we have observed an approximately 30%...The introduction of highly active antiretroviral therapy(HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome.In developed countries,we have observed an approximately 30% reduction in the prevalence of human immunodeficiency virus(HIV)-associated cardiomyopathy,possibly related to a reduction of opportunistic infections and myocarditis.In developing countries,however,where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant,we have observed an approximately 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure.Also,some HAART regimens in developed countries,especially those including protease inhibitors,have been shown to cause,in a high proportion of HIV-infected patients,an iatrogenic metabolic syndrome(HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis,even in young HIV-infected people.Careful cardiac screening is warranted for patients who are being evaluated for,or who are receiving,HAART regimens,particularly for those with known underlying cardiovascular risk factors.A close collaboration between car-diologists and infectious disease specialists is needed for decisions regarding the use of antiretrovirals,for a careful stratification of cardiovascular risk factors,and for cardiovascular monitoring of HIV-infected patients receiving HAART,according the most recent clinical guidelines.展开更多
For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of H...For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.展开更多
Mesenchymal stem cells(MSCs) derived from human induced pluripotent stem cells(hiPSCs) provide a novel source for generating adipocytes, thus opening new avenues for fundamental research and clinical medicine. We pres...Mesenchymal stem cells(MSCs) derived from human induced pluripotent stem cells(hiPSCs) provide a novel source for generating adipocytes, thus opening new avenues for fundamental research and clinical medicine. We present the adipogenic potential of hiPSCs and the various methods to derive hiPSC-MSCs. We discuss the main characteristic of hiPSC-MSCs, which is their low adipogenic capacity as compared to adult-MSCs. Finally, we propose several hypotheses to explanation this feature, underlying a potential critical role of the micro-environment. We favour the hypothesis that the range of factors or culture conditions required to induce adipocyte differentiation of MSCs derived from adult tissues and from embryonic-like cells could differ.展开更多
Severe insulin resistance has been linked to some of the most globally prevalent disorders,such as diabetes mellitus,nonalcoholic fatty liver disease,polycystic ovarian syndrome,and hypertension.Hereditary severe insu...Severe insulin resistance has been linked to some of the most globally prevalent disorders,such as diabetes mellitus,nonalcoholic fatty liver disease,polycystic ovarian syndrome,and hypertension.Hereditary severe insulin resistance syndrome(H-SIRS)is a rare disorder classified into four principal categories:primary insulin receptor defects,lipodystrophies,complex syndromes,and obesity-related H-SIRS.Genes such as INSR,AKT2,TBC1D4,AGPAT2,BSCL2,CAV1,PTRF,LMNA,PPARG,PLIN1,CIDEC,LIPE,PCYT1A,MC4R,LEP,POMC,SH2B1,RECQL2,RECQL3,ALMS1,PCNT,ZMPSTE24,PIK3R1,and POLD1 have been linked to H-SIRS.Its clinical features include insulin resistance,hyperglycemia,hyperandrogenism,severe dyslipidemia,fatty liver,abnormal topography of adipose tissue,and low serum leptin and adiponectin levels.Diagnosis of H-SIRS is based on the presence of typical clinical features associated with the various H-SIRS forms and the identification of mutations in H-SIRS-linked genes by genetic testing.Diet therapy,insulin sensitization,exogenous insulin therapy,and leptin replacement therapy have widely been adopted to manage H-SIRS.The rarity of H-SIRS,its highly variable clinical presentation,refusal to be tested for genetic mutations by patients’family members who are not severely sick,unavailability of genetic testing,and testing expenses contribute to the delayed or underdiagnoses of H-SIRS.Early diagnosis facilitates early management of the condition,which results in improved glycemic control and delayed onset of diabetes and other complications related to severe insulin resistance.The use of updated genetic sequencing technologies is recommended,and long-term studies are required for genotype–phenotype differentiation and formulation of diagnostic and treatment protocols.展开更多
Background An zidovudine (AZT)-substitution regimen containing 24-week stavudine (d4T) followed by long-term AZT for HIV therapy is potential to trade off short-term AZT-related anemia and long-term risks associat...Background An zidovudine (AZT)-substitution regimen containing 24-week stavudine (d4T) followed by long-term AZT for HIV therapy is potential to trade off short-term AZT-related anemia and long-term risks associated with d4T in resourcelimited settings.However,evidence is scarce.This study aims to assess the efficacy and safety of AZT-substitution regimen,aiming to find a regimen with better efficacy,less adverse events,and more affordability in resource-limited settings.Methods This prospective,multicenter study enrolled 499 (190 on d4T regimen,172 on AZT regimen,and 137 on AZT-substitution regimen) HIV-1-infected subjects who initiated combined antiretroviral therapy and attended follow-up visits over 96 weeks from 2009 to 2011.Lamivudine (3TC) and either nevirapine (NVP) or efavirenz (EFV) were the other two drugs in the antiretroviral regimens.Virologic and immunologic responses and adverse events were monitored at baseline and at weeks 4,12,24,36,48,60,72,84,and 96.Results In terms of hematological adverse effects,AZT-substitution group had similar safety profiles to d4T group and was superior to AZT group.In comparison with AZT-substitution group,AZT group was associated with higher risk of developing anemia (adjusted hazard ratio (aHR)for anemia ≥ grade Ⅱ,8.44,95% CI 1.81-39.46) and neutropenia (aHR for neutropenia ≥ grade Ⅱ,1.86,95% CI 1.19-2.93).The prevalence of lipodystrophy in d4T group was 19.5%,while that in AZT-substitution group was zero.As to antiretroviral efficacy,these three groups showed no differences.Conclusion AZT-substitution regimen provides a relatively safe and effective first-line antiretroviral strategy in resource-limited settings.展开更多
Aim: Brachioplasty in patients who are normal weight, with moderate skin excess and who are not accepting long scars, remains a challenge for plastic surgeons. Methods: We present our experience in 47 patients with sh...Aim: Brachioplasty in patients who are normal weight, with moderate skin excess and who are not accepting long scars, remains a challenge for plastic surgeons. Methods: We present our experience in 47 patients with short scar brachioplasty in combination with posterolateral liposuction, fascia anchoring and fat grafting in the inferomedial arm in order to improve skin quality and correct minor irregularities. Patients' satisfaction rates were evaluated after 3 and 6 months following the procedure. Results: Patients (groups IIa, IIb and IIIa according to Rohrich classification) showed high satisfaction rates with the result both after 3 and 6 months after the procedure. The results were maintained. There were 2 cases (4.2%) of isolated wound dehiscence occurred, which were all resolved conservatively with dressings and antibiotics. Conclusion: The technique presented in this paper has shown to be an easy and effective solution for a diverse selection of patients suffering brachial lipodystrophy. Limited scar brachioplasty only has specific applications, and should not be considered a replacement for traditional brachioplasty.展开更多
文摘Objective: The measurement of phase angles is an important monitoring parameter and supplementation with omega-3 could promote benefits by modulating the electrical potential of membranes and increasing body cell mass. This study aimed to evaluate the effectiveness of omega-3 fatty acid supplementation on the phase angle of people living with HIV/AIDS. Methods: In this study, 63 individuals of all genders who were undergoing outpatient follow-up and showed lipodystrophy due to highly active antiretroviral therapy were analyzed. Our sample consisted of two groups, one that received supplementation containing 2550 mg of omega-3/day (1080 mg of eicosapentaenoic acid and 720 mg of docosahexaenoic acid) for three months (n = 32) and another that underwent nutrition guidance (n = 31). Phase angle and body cell mass were assessed for both groups and compared at the beginning of research (T0) and after our intervention (T1) for each group separately. Results: Phase angle averaged 6.45° ± 1.06 SD. The comparison between T0 and T1 showed a significant increase in phase angle and body cell mass, whereas the guidance group showed a decrease in body cell mass at T1 in relation to T0, with a significant p-value. Variance in phase angle between moments showed significant values between T0 and T1 in the supplementation group for all genders. Conclusion: Omega-3 positively modulated patients phase angle and body cell mass, but we emphasize the need for other studies that can solidify knowledge about supplementation dosage and intervention time.
文摘BACKGROUND Latent autoimmune diabetes in adults(LADA)is a special type of type 1 diabetes mellitus.During the early stages,patients with LADA are treated with oral antidiabetics.However,insulin treatment is still required as islet function gradually declines.Once patients have developed insulin allergy,clinical treatment and nursing care become very challenging.CASE SUMMARY Here,we report a case of LADA with insulin-related lipodystrophy,allergy,and exogenous insulin autoimmune syndrome during insulin treatment,thus making it very difficult to effectively control glucose levels with insulin.We attempted subcutaneous injection and an insulin pump to desensitize the patient’s response to insulin,and finally assisted the doctor to select the appropriate insulin treatment for the patient.We describe the management of this patient from a nursing viewpoint.CONCLUSION We summarize the nursing experience of a case with complex insulin allergy requiring desensitization treatment.Our approach is very practical and can be applied to similar patients needing insulin desensitization.
文摘The occurrence of lipodystrophy in patients taking antihuman immunodeficiency virus(HIV) medications is a serious problem as it is irreversible even after drug withdrawal. Although it was first recognized in patients taking proteinase inhibitors, other types of anti-HIV agents can also cause lipodystrophy. In a recent publication by Jones et al entitled "Highly active antiretroviral therapy dysregulates proliferation and differentiation of human pre-adipocytes" in World Journal of Virology, it was reported that simultaneous treatment of human subcutaneous adipocytes with anti-HIV drugs with different mechanisms of action synergistically exerted antiadipogenesis effects in vitro, warning us to take utmost care in every case receiving combination antiretroviral therapy(cART). For elucidation of the molecular basis for cART-related lipodystrophy, multi-faceted approaches should be taken, based on a deeper understanding of the development and organization of adipose tissues.
文摘Dunnigan-type partial lipodystrophy, which is characterized by a number of metabolic alterations, change in body fat distribution, and autosomal dominant inheritance pattern, is rare in the general population. Objective: To report the case of an adolescent with clinical and laboratory findings suggestive of Dunnigan-type partial lipodystrophy. Methods: Case report and literature review. Results: A 15-year-old adolescent presented at the clinic complaining of darkening of skin folds on her trunk and back. During physical examination, the presence of serious acanthosis nigricans in her cervical region, axillae, and intergluteal space was noted. Hirsutism in androgen-dependent areas was also observed, as well as relevant reduction of subcutaneous adipose tissue in the limbs, gluteal region, abdomen, and trunk and fat accumulation in the face and chin. Discussion. Dunnigan-type familial partial lipodystrophy is a rare dominant autosomal disease resulting from a heterozygous missense mutation in the LMNA gene, known as LPF type 2 (Dunnigan variant), which encodes the nuclear protein A/C-type lamin. It is characterized by the progressive disappearance of the subcutaneous adipose tissue in the limbs, gluteal region, abdomen, and trunk, with onset in puberty, followed by fat accumulation in other areas such as the face, chin, labia majora, and intra-abdominal region, leading to hypertrophy that may mimic the Cushing’s syndrome phenotype. Affected patients display marked insulin resistance and may consequently develop diabetes mellitus, acanthosis nigricans, hirsutism, and polycystic ovary syndrome. Conclusion: This case report highlights the importance of suspecting Dunnigan-type familial partial lipodystrophy in clinical practice. Early clinical diagnosis allows for measures that minimize the severe metabolic disorders associated with this disease and, consequently, these adolescents’ self-esteem issues.
文摘Congenital lipodystrophy is a group of rare syndrome characterized by the absence of subcutaneous tissue. Affecting less per million live birth, this condition associate metabolic disturbance including severe insulin resistance and progeroid appearance. Diagnosis may be fortuitous or related to complications as presented in the present case series. Lipodystrophy can be generalized or localized. Acquired lipodystrophy is associated with some drugs like antiretroviral. Thus, the condition is well described in African HIV patients but data on congenital forms from Sub Saharan Africa are sparse, justifying the present report. We present four cases, with peculiar appearance associated with increased blood triglycerides. Two on four of the patients presented diabetes mellitus. Genetic testing was not available, questioning the actual guidelines of diagnosis for our context.
文摘A subset of HIV-1 infected patients undergoing antiretroviral treatment with HIV-1 protease inhibitors (PI’s) develops a syndrome called Lipodystrophy of HIV (LDHIV). LDHIV is characterized by loss of peripheral subcutaneous adipose tissue (face, limbs, buttocks), visceral fat accumulation, and in some cases, lipomatosis in the neck and dorsocervical area .We describe the clinical and imaging features of LDHIV in the head and neck in a series of 5 cases. There is a consistent pattern of fat accumulation in the dorsocervical region with paucity of fat in the face. This classic appearance should be recognized as potentially related to drug toxicity in the HIV infected population.
文摘Currently, with the increase in life expectancy of people living with HIV (PLHIV), it is essential to analyze the biopsychosocial aspects involved in satisfaction with quality of life and its multidimensionality, because although HAART produces hope for the control of HIV, can have important emotional consequences. Thus, the aim of the present study was to evaluate the effects of lipodystrophy (LDS) on self-esteem and body image of PLHIV in Brazil. It is a psychoanalytic method by semi-structured interview, a body image scale and two drawings that represent the patients’ body image before and after. The diagnosis of LDS was by self-report. Sixteen patients 8 (eight men and 8 women), with a mean age of 43 years, were invited to the HIV-Out ADEE 3002 outpatient clinic of the Dermatology Clinic of the Central Institute of a University Hospital in São Paulo. It was noted that 50% of patients reported physical problems and 25% consequences in the family and social sphere. There were increased bodily changes, family problems and social prejudices after HAART and the self-esteem of 88% of patients were shown to be “little adjusted” to their condition. For 63%, physical appearance was a concern and 87% of them reported body dissatisfaction. Patients also reported impact on their sexuality (75% felt less attractive and 88% with reduced libido after starting LDS). The interviews, drawings and body image scale showed important changes in the lives of patients with lipodystrophy, where negative changes in appearance and effects on self-image were observed. This diagnosis seems to influence other aspects of social life, which can lead to prejudice in relation to illness and, therefore, isolation.
文摘Management of Human Immunodeficiency Virus infection remains a major challenge in many sub-Saharan African countries. Antiretroviral drugs which have reduced significantly the mortality rate of this pandemic disease are a source of side effects. Among these side effects, adult lipodystrophy has already been described by several authors. The aim of this study is to determine the prevalence of lipodystrophy and associate factors in children on antiretroviral therapy, managed at Charles De Gaulle Children University Hospital and Yalgado Ouedrago University Hospital in Ouagadougou, Burkina Faso. This is a cross-sectional study conducted from June 2013 to January 2014. We included children aged 2 to 15 years who had been on antiretroviral treatment for at least six months with no severe acute malnutrition (wasting). Lipodystrophy was diagnosed clinically after assessment of morphological changes. Overall, 323 children complying with the inclusion criteria were examined. The average duration of antiretroviral therapy was 5.3 years. Forty five children had lipodystrophy, i.e. 13.9% prevalence rate. One hundred and twenty seven different lipodystrophic lesions were noted, hence 82.7% lipoatrophy and 17.3% lipohypertrophy. The most common presentations were: face (32%), lower limbs (26%) and upper limbs (15.7%). Factors associated with lipoatrophy were: age above 10 years (P = 0.004);male gender (P = 0.0004);antiretroviral treatment duration of more than 60 months (P < 0.001) and treatment with stavudine (P = 0.01). Our study showed that lipodystrophy is not exceptional in children on antiretroviral therapy in Ouagadougou. However, more researches on lipid profiles of these children are necessary to prevent other common complications related to fat accumulation.
文摘Context: Highly active antiretroviral therapy (HAART) inhibits the HIV replication and consequently increases CD4 levels and decreases viral load. This immune system improvement can trigger various immunological phenomena, entity called Immune Reconstitution Syndrome (IRS). Graves’ disease is a late Immune Reconstitution consequence. Patient: We report the case of a 48 years old man with HIV infection who developed Graves’ disease three years after he was on effective HAART because of the Immune Reconstitution Syndrome. At presentation he had a very low CD4 T-cell count (17 cells/μL). When he started HAART he presented a lipodystrophy syndrome. HAART was changed because of the persistent low CD4-T cells count (less than 100 cell/μL). Afterwards serum lipid levels began to decrease and that was the first manifestation of Graves’ disease, which was diagnosed when CD4 T-cells increased up to 343 cell/μL. Our patient developed Graves’ disease 36 months after initiating effective HAART with protease inhibitors which was coincident with viral suppression and a rise of CD4 T cells. Conclusion: The most immunosuppressed patients with a CD4 T cell count less than 100 cells/μL are at greatest risk for the development of Immune Reconstitution Syndrome after HAART initiation. We conclude that clinicians will have to consider the importance of the early diagnosis of thyroid disease to bring an adequate treatment.
文摘AIM To investigate the mechanism(s) by which potential effects of multi-drug highly-active antiretroviral therapy contributes to lipodystrophy syndrome. METHODS Preadipocytes from healthy donors were assessed for proliferation and differentiation in the presence of nucleoside reverse transcriptase inhibitors(NRTIs), nonnucleoside reverse transcriptase inhibitors(NNRTIs), and protease inhibitors(PIs) individually and in combination. Effects on proliferation were assessed with a 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide assay and effects on differentiation were assessed from glycerol-3-phosphate dehydrogenase(GPDH) activity and quantitation of Oil Red O staining for intracellular lipid. Data were analyzed with a randomized block ANOVA with post-hoc Fisher's Least Significant Difference test. RESULTS Preadipocyte proliferation was inhibited by a combination of NNRTI + NRTI(14% at 48 h, P < 0.001) and PI + NRTI(19% at 48 h, P < 0.001) with additional suppression when ritonavir(RTV) was added(26% at 48 h). The drug combination of atazanavir(ATV) + RTV + emtricitabine(FTC) + tenofovir(TDF) had the greatest inhibitory effect on proliferation at 48 h. Preadipocyte differentiation was most significantly reduced by the efavirenz + FTC + TDF assessed either by GPDH activity(64%) or lipid accumulation(39%), P < 0.001. Combining NRTIs with a PI(ATV + FTC + TDF) significantly suppressed differentiation(GPDH activity reduced 29%, lipid accumulation reduced by 19%, P < 0.01). This effect was slightly greater when a boosting amount of RTV was added(ATV + FTC + TDF + RTV, P < 0.001). CONCLUSION Although combination antiretroviral therapy is clinically more efficacious than single drug regimens, it also has a much greater inhibitory effect on preadipocyte proliferation and differentiation.
文摘The introduction of highly active antiretroviral therapy(HAART) has generated a contrast in the cardiac manifestations of acquired immunodeficiency syndrome.In developed countries,we have observed an approximately 30% reduction in the prevalence of human immunodeficiency virus(HIV)-associated cardiomyopathy,possibly related to a reduction of opportunistic infections and myocarditis.In developing countries,however,where the availablity of HAART is limited and the pathogenic impact of nutritional factors is significant,we have observed an approximately 32% increase in the prevalence of HIV-associated cardiomyopathy and a related high mortality rate from congestive heart failure.Also,some HAART regimens in developed countries,especially those including protease inhibitors,have been shown to cause,in a high proportion of HIV-infected patients,an iatrogenic metabolic syndrome(HIV-lipodystrophy syndrome) that is associated with an increased risk of cardiovascular events related to a process of accelerated atherosclerosis,even in young HIV-infected people.Careful cardiac screening is warranted for patients who are being evaluated for,or who are receiving,HAART regimens,particularly for those with known underlying cardiovascular risk factors.A close collaboration between car-diologists and infectious disease specialists is needed for decisions regarding the use of antiretrovirals,for a careful stratification of cardiovascular risk factors,and for cardiovascular monitoring of HIV-infected patients receiving HAART,according the most recent clinical guidelines.
基金financially supported in the our laboratory with resources from The National Council of Technological and Scientific Developmentthe State of Sao Paulo Research Foundationthe National Institute of Science and Technology of Complex Fluids.
文摘For human immunodeficiency virus(HIV)-infected patients, the 1990s were marked by the introduction of highly active antiretroviral therapy(HAART) representing a new perspective of life for these patients. The use of HAART was shown to effectively suppress the replication of HIV-1 and dramatically reduce mortality and morbidity, which led to a better and longer quality of life for HIV-1-infected patients. Apart from the substantial benefits that result from the use of various HAART regimens, laboratory and clinical experience has shown that HAART can induce severe and considerable adverse effects related to metabolic complications of lipid metabolism, characterized by signs of lipodystrophy, insulin resistance, central adiposity, dyslipidemia, increased risk of cardiovascular disease and even an increased risk of atherosclerosis. New drugs are being studied, new therapeutic strategies are being implemented, and the use of statins, fibrates, and inhibitors of intestinal cholesterol absorption have been effective alternatives. Changes in diet and lifestyle have also shown satisfactory results.
文摘Mesenchymal stem cells(MSCs) derived from human induced pluripotent stem cells(hiPSCs) provide a novel source for generating adipocytes, thus opening new avenues for fundamental research and clinical medicine. We present the adipogenic potential of hiPSCs and the various methods to derive hiPSC-MSCs. We discuss the main characteristic of hiPSC-MSCs, which is their low adipogenic capacity as compared to adult-MSCs. Finally, we propose several hypotheses to explanation this feature, underlying a potential critical role of the micro-environment. We favour the hypothesis that the range of factors or culture conditions required to induce adipocyte differentiation of MSCs derived from adult tissues and from embryonic-like cells could differ.
基金supported by the National Natural Science Foundation of China(No.8217033609,81770880,81800788,and 81970762)the Science&Technology Department of Hunan Province(China)(No.2020SK2080,and 2015JC3012)Changsha Science&Technology(China)(No.k1906019,and kq1901118).
文摘Severe insulin resistance has been linked to some of the most globally prevalent disorders,such as diabetes mellitus,nonalcoholic fatty liver disease,polycystic ovarian syndrome,and hypertension.Hereditary severe insulin resistance syndrome(H-SIRS)is a rare disorder classified into four principal categories:primary insulin receptor defects,lipodystrophies,complex syndromes,and obesity-related H-SIRS.Genes such as INSR,AKT2,TBC1D4,AGPAT2,BSCL2,CAV1,PTRF,LMNA,PPARG,PLIN1,CIDEC,LIPE,PCYT1A,MC4R,LEP,POMC,SH2B1,RECQL2,RECQL3,ALMS1,PCNT,ZMPSTE24,PIK3R1,and POLD1 have been linked to H-SIRS.Its clinical features include insulin resistance,hyperglycemia,hyperandrogenism,severe dyslipidemia,fatty liver,abnormal topography of adipose tissue,and low serum leptin and adiponectin levels.Diagnosis of H-SIRS is based on the presence of typical clinical features associated with the various H-SIRS forms and the identification of mutations in H-SIRS-linked genes by genetic testing.Diet therapy,insulin sensitization,exogenous insulin therapy,and leptin replacement therapy have widely been adopted to manage H-SIRS.The rarity of H-SIRS,its highly variable clinical presentation,refusal to be tested for genetic mutations by patients’family members who are not severely sick,unavailability of genetic testing,and testing expenses contribute to the delayed or underdiagnoses of H-SIRS.Early diagnosis facilitates early management of the condition,which results in improved glycemic control and delayed onset of diabetes and other complications related to severe insulin resistance.The use of updated genetic sequencing technologies is recommended,and long-term studies are required for genotype–phenotype differentiation and formulation of diagnostic and treatment protocols.
文摘Background An zidovudine (AZT)-substitution regimen containing 24-week stavudine (d4T) followed by long-term AZT for HIV therapy is potential to trade off short-term AZT-related anemia and long-term risks associated with d4T in resourcelimited settings.However,evidence is scarce.This study aims to assess the efficacy and safety of AZT-substitution regimen,aiming to find a regimen with better efficacy,less adverse events,and more affordability in resource-limited settings.Methods This prospective,multicenter study enrolled 499 (190 on d4T regimen,172 on AZT regimen,and 137 on AZT-substitution regimen) HIV-1-infected subjects who initiated combined antiretroviral therapy and attended follow-up visits over 96 weeks from 2009 to 2011.Lamivudine (3TC) and either nevirapine (NVP) or efavirenz (EFV) were the other two drugs in the antiretroviral regimens.Virologic and immunologic responses and adverse events were monitored at baseline and at weeks 4,12,24,36,48,60,72,84,and 96.Results In terms of hematological adverse effects,AZT-substitution group had similar safety profiles to d4T group and was superior to AZT group.In comparison with AZT-substitution group,AZT group was associated with higher risk of developing anemia (adjusted hazard ratio (aHR)for anemia ≥ grade Ⅱ,8.44,95% CI 1.81-39.46) and neutropenia (aHR for neutropenia ≥ grade Ⅱ,1.86,95% CI 1.19-2.93).The prevalence of lipodystrophy in d4T group was 19.5%,while that in AZT-substitution group was zero.As to antiretroviral efficacy,these three groups showed no differences.Conclusion AZT-substitution regimen provides a relatively safe and effective first-line antiretroviral strategy in resource-limited settings.
文摘Aim: Brachioplasty in patients who are normal weight, with moderate skin excess and who are not accepting long scars, remains a challenge for plastic surgeons. Methods: We present our experience in 47 patients with short scar brachioplasty in combination with posterolateral liposuction, fascia anchoring and fat grafting in the inferomedial arm in order to improve skin quality and correct minor irregularities. Patients' satisfaction rates were evaluated after 3 and 6 months following the procedure. Results: Patients (groups IIa, IIb and IIIa according to Rohrich classification) showed high satisfaction rates with the result both after 3 and 6 months after the procedure. The results were maintained. There were 2 cases (4.2%) of isolated wound dehiscence occurred, which were all resolved conservatively with dressings and antibiotics. Conclusion: The technique presented in this paper has shown to be an easy and effective solution for a diverse selection of patients suffering brachial lipodystrophy. Limited scar brachioplasty only has specific applications, and should not be considered a replacement for traditional brachioplasty.