View source for WBR0871

 {{WBRQuestion
|QuestionAuthor= {{SSK}} (Reviewed by Serge Korjian)
|ExamType=USMLE Step 1
|MainCategory=Immunology
|SubCategory=General Principles
|MainCategory=Immunology
|SubCategory=General Principles
|MainCategory=Immunology
|SubCategory=General Principles
|MainCategory=Immunology
|MainCategory=Immunology
|MainCategory=Immunology
|SubCategory=General Principles
|MainCategory=Immunology
|SubCategory=General Principles
|MainCategory=Immunology
|SubCategory=General Principles
|MainCategory=Immunology
|SubCategory=General Principles
|MainCategory=Immunology
|MainCategory=Immunology
|SubCategory=General Principles
|Prompt=A 34-year-old woman diagnosed with HIV 6 months ago with latest CD4 count of 222 presents to the HIV clinic for follow-up. The patient had been doing well, but complains of difficulty losing weight despite proper exercise and diet. On physical exam, the physician notices significant fat loss in the face, arms and legs with marked abdominal obesity. He also notes fat collection in her upper back in close proximity to her neck. Which of the following medications can explain the patient's current presentation?
|Explanation=Lipodystrophy is a condition involving the adipose tissue that leads to loss of fat in certain areas on the body with accumulation of fat in other locations. In the context of HIV, some form of lipodystophy occurs in around 15-20% of patients on protease inhibitor therapy although the exact mechanism is unknown. Patients can have manifestations resembling Cushing syndrome. Patients usually present with fat loss in the face and extremities with central fat accumulation and "buffalo hump"-like fat deposits in the upper back. Protease inhibitor associated lipodystrophy usually does not resolve after the agent is discontinued.
|AnswerA=Saquinavir
|AnswerAExp=Saquinavir is a protease inhibitor that can sometimes lead to lipodystrophy in patients on HAART therapy.
|AnswerB=Tenofovir
|AnswerBExp=Tenofovir is a NRTI and usually does not cause lipodystrophy. It is usually associated with bone marrow suppression.
|AnswerC=Nevirapine
|AnswerCExp=Nevirapine is a NNRTI and usually does not cause lipodystrophy.
|AnswerD=Raltegravir
|AnswerDExp=Raltegravir is an integrase inhibitor and usually does not cause lipodystrophy.
|AnswerE=Zidovudine
|AnswerEExp=Zidovudine is a NRTI and usually does not cause lipodystrophy. It is usually associated with bone marrow suppression.
|EducationalObjectives=An important side effect of protease inhibitors is lipodystrophy.
|References=Martínez E, Mocroft A, García-Viejo MA, et al. Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study. The Lancet. 2001;357(9256):592-598.<br>
First Aid 2015 page 194

|RightAnswer=A
|WBRKeyword=Lipodystrophy, Protease inhibitors, HIV, Pharmacology, Side effect,
|Approved=Yes
}}