Improvement of Fat Redistribution, Insulin Resistance
and Hepatic Fatty Infiltration in HIV - Associated Lipo
dystrophy Syndrome by Pioglitazone : A Case Report
WISIT PRASITHSIRIKUL, MD*,
PONGAMORN BUNNAG, MD**
Affiliation : * Bamrasnaradura Institute, Nonthaburi 11000,
Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
AbstractHIV -associated lipodystrophy syndrome is a syndrome occurring in HIV -infected patients
who were treated with highly-active antiretroviral therapy (HAART), especially regimen containing
protease inhibitors. The syndrome consists of fat redistribution, with loss of subcutaneous fat and
increase in visceral fat, and metabolic disturbances, including glucose intolerance or overt diabetes and
dyslipidemia. No standard treatment has been established for this syndrome. Pioglitazone is an oral
antidiabetic agent that acts primarily on adipose tissue to reduce insulin resistance. The authors report
a 50-year old HIV -infected woman who developed HIV -associated lipodystrophy syndrome after 3
months of HAART. She had significant weight loss with obvious loss of subcutaneous fat, together
with development of hypertension, diabetes and dyslipidemia. After treatment with 30 milligrams of
pioglitazone daily, her body weight increased within the first month of treatment. Subcutaneous fat
loss was restored. Improvement in glycemic and lipid control was also noted. CT scan of the abdomen
revealed that fatty infiltration in the liver was markedly decreased. Visceral fat as assessed by CT scan
had also decreased. Pioglitazone appeared to have beneficial effects in this patient.
Keywords : HIV-Associated Lipodystrophy, Pioglitazone, Insulin Resistance
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