Hyperinsulinemia induced by highly active antiretroviral therapy in an adolescent with polycystic ovary syndrome who was infected with HIV

Objective: To report a case of polycystic ovary syndrome (PCOS) in an adolescent infected with human immunodeficiency virus (HIV) and lipodystrophy whose insulin resistance was induced by highly active antiretroviral therapy (HAART). Design: Case report. Setting: Academic department of pediatrics. Patient(s): A 14-year-old vertically HIV-infected adolescent receiving HAART. Intervention(s): Clinical observation, metabolic and endocrinologic assessment, imaging of ovaries by ultrasound, and of intra-abdominal adipose tissue content by magnetic resonance imaging. Main Outcome Measure(s): Lipodystrophy, insulin resistance, PCOS. Result(s): After 34 months of HAART this adolescent showed lipodystrophy with central obesity and insulin resistance after oral glucose tolerance test (OGTT). Ovaries were normal at ultrasonography. After 56 weeks of HAART, the adolescent showed more severe evidence of lipodystrophy and insulin resistance, and she developed acne, hirsutism, and amenorrhea. The following hormone levels were elevated: FSH 5.9 mUI/mL, LH 15.4 mUI/mL, LH/FSH ratio >2.5, free T 5.6 pg/mL, DHEAS 2,070 ng/mL, androstenedione (A) 3.42 ng/mL; whereas 17-β-E2, P, PRL, and free T4 values were within the normal range. Ultrasonography demonstrated a typical polycystic echographic architecture of the ovaries. Conclusion(s): Lipodystrophy and insulin resistance are well-recognized side effects of HAART. Polycystic ovary syndrome might be an additional side effect secondary to insulin resistance and lipodystrophy.