Longitudinal evolution of HIV‐1‐associated lipodystrophy is correlated to serum cortisol:DHEA ratio and IFN‐α

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Abstract
Background We have previously shown that lipid alterations in HIV‐1‐associated lipodystrophy (LD) are correlated with decreased serum dehydroepiandosterone (DHEA) and increased cortisol:DHEA ratio and IFN‐α levels.Objective To evaluate in a longitudinal study whether steroid and cytokine modifications are associated with the evolution of physical changes and lipid alterations associated with LD.Methods Thirty‐four HIV‐1‐positive men were followed during 32·5 ± 4·0 months and tested at four time‐points. The patients were subdivided into five groups according to physical changes and anthropometric measurements: LD‐negative, initially LD‐negative becoming LD‐positive, LD‐positive unchanged, aggravated or improved. Serum lipids, apolipoproteins, adrenal steroids and cytokines were measured and compared with baseline values.Results (1) LD aggravation is associated with persistent elevated lipids, a decrease in serum DHEA, an increase in cortisol:DHEA ratio and persistent high levels of IFN‐α. (2) LD improvement is associated with normalization of serum lipids, an increase in serum DHEA leading to normalization in cortisol:DHEA ratio, and normalization of IFN‐α levels. (3) In LD‐positive men evolution of VLDL cholesterol is negatively correlated with DHEA (r = −0·56, P < 0·01) and positively with cortisol:DHEA ratio (r = 0·62, P < 0·004) and with IFN‐α (r = 0·57, P < 0·01). (4) The switch to LD is associated with a decrease in serum DHEA. (5) Patients who remained LD‐negative maintained normal lipids, elevated cortisol and DHEA, and normal cortisol:DHEA ratio and normal levels of IFN‐α.Conclusions This study indicates that cortisol:DHEA ratio and serum IFN‐α levels are closely associated with clinical evolution and atherogenic lipid alterations in LD.