CHANGE IN ADIPOKINES LEVELS

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Leptin levels remain about the same through the first four visits and then increase after long term (3-6 years) of HAART use.  Higher leptin levels are usually indicative of more adipose tissue.  Leptin or some pre-cursor may not respond properly in this setting to HIV infection plus HAART treatment over a longer time period.

Adiponectin levels vary over visits.  They decrease from preseroconversion to postseroconversion and again postseroconversion to 1^st HAART and then level off between the HAART visits.  Adiponectin should be affected by BMI and BMI does not change much from visit to visit.  Its expression is suppressed in patients with obesity and type 2 diabetes, showing an inverse relationship with insulin resistance and visceral adiposity [4].  The lack of influence from BMI could be a product of the variation within the sampling time points.    Other studies have used waist circumference, waist to hip ratio, carotid artery thickness, visceral adipose tissue (VAT) vs. subcutaneous adipose tissue (SAT), and fat mass as measured by DEXA [32].

Resistin did not change over time in our analysis.  The previous human literature also showed that resistin was not associated with abnormalities of lipid metabolism.  IL-6 and TNF-alpha level, the pro-inflammatory cytokines, increased at postseroconversion and again at the 1^st HAART visit, as these systemic cytokines, meaning not only fat based, becomes elevated during the body’s immune response.  Both IL-6 and TNF-alpha levels decrease as patients continue on HAART with TNF-alpha almost returning to preseroconversion levels. However, IL-6 remains higher than preseroconversion at the 3^rd HAART visit.  These results suggest that adiponectin and IL-6 remain altered during HAART therapy while leptin, resistin and TNF-alpha return to preseroconversion levels.