WBR0871

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Immunology
Sub Category	SubCategory::General Principles
Prompt	[[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?]]
Answer A	AnswerA::Saquinavir
Answer A Explanation	AnswerAExp::Saquinavir is a protease inhibitor that can sometimes lead to lipodystrophy in patients on HAART therapy.
Answer B	AnswerB::Tenofovir
Answer B Explanation	AnswerBExp::Tenofovir is a NRTI and usually does not cause lipodystrophy. It is usually associated with bone marrow suppression.
Answer C	AnswerC::Nevirapine
Answer C Explanation	AnswerCExp::Nevirapine is a NNRTI and usually does not cause lipodystrophy.
Answer D	AnswerD::Raltegravir
Answer D Explanation	AnswerDExp::Raltegravir is an integrase inhibitor and usually does not cause lipodystrophy.
Answer E	AnswerE::Zidovudine
Answer E Explanation	AnswerEExp::Zidovudine is a NRTI and usually does not cause lipodystrophy. It is usually associated with bone marrow suppression.
Right Answer	RightAnswer::A
Explanation	[[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 face and extremities with central fat accumulation manifesting as abdominal obesity and "buffalo hump"-like fat deposits in the upper back. Protease inhibitor associated lipodystrophy usually does not resolve after the agent is discontinued. Educational objective: Reference: Educational Objective: An important side effect of protease inhibitors is lipodystrophy. References: First Aid 2015 page 194 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.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Lipodystrophy, WBRKeyword::Protease inhibitors, WBRKeyword::HIV, WBRKeyword::Pharmacology, WBRKeyword::Side effect
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::