Adipocytokine dysregulation, abnormal glucose metabolism, and lipodystrophy in HIV-infected adolescents receiving protease inhibitors
•32.5% of PIs-treated adolescents had lipodystrophy: 10% with lipohypertrophy.•87.5% of adolescents with any lipohypertrophy had abnormal glucose metabolism.•Lipoatrophy had similar rate of abnormal glucose metabolism to non-lipodystrophy.•Abnormal adipocytokines were more profound in adolescents wi...
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| Veröffentlicht in: | Cytokine (Philadelphia, Pa.) Pa.), 2020-12, Vol.136, p.155145-155145, Article 155145 |
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| creator | Santiprabhob, Jeerunda Chokephaibulkit, Kulkanya Khantee, Puttichart Maleesatharn, Alan Phonrat, Benjaluck Phongsamart, Wanatpreeya Lapphra, Keswadee Wittawatmongkol, Orasri Rungmaitree, Supattra Tanchaweng, Surapong Maturapat, Sirinoot Lermankul, Watcharee Tungtrongchitr, Rungsunn |
| description | •32.5% of PIs-treated adolescents had lipodystrophy: 10% with lipohypertrophy.•87.5% of adolescents with any lipohypertrophy had abnormal glucose metabolism.•Lipoatrophy had similar rate of abnormal glucose metabolism to non-lipodystrophy.•Abnormal adipocytokines were more profound in adolescents with any lipohypertrophy.•No difference in resistin level found among different types of lipodystrophy.
Lipodystrophy is common in HIV-infected patients receiving protease inhibitors (PIs), stavudine, and zidovudine. Adipocytokines may be altered in lipodystrophy. We evaluated risk factors, adipocytokine levels, insulin resistance, and lipid profiles in HIV-infected adolescents with different lipodystrophy types.
A cross-sectional study was conducted in 80 perinatally HIV-infected adolescents receiving PI-based highly active antiretroviral therapy for ≥ 6 months. Patients underwent oral glucose tolerance tests and measurements of high-molecular-weight (HMW) adiponectin, leptin, resistin, insulin, and lipids. They were classified into 3 groups based on the clinical findings: no lipodystrophy, isolated lipoatrophy, and any lipohypertrophy (isolated lipohypertrophy or combined type).
Of the 80 patients (median age, 16.7 years), 18 (22.5%) had isolated lipoatrophy, while 8 (10%) had any lipohypertrophy (four with isolated lipohypertrophy, and four with the combined type). In a multivariate analysis, longer exposure to stavudine (OR: 1.03; 95% CI, 1.01–1.06; p = 0.005) and indinavir (OR: 1.03; 95% CI, 1.01–1.06; p = 0.012) were associated with lipoatrophy, while longer exposure to didanosine (OR: 1.04; 95% CI, 1.01–1.08; p = 0.017) and indinavir (OR: 1.10; 95% CI, 1.00–1.21; p = 0.045) were associated with any lipohypertrophy. Leptin levels were highest in the any-lipohypertrophy group and lowest in the isolated-lipoatrophy group (p = 0.013). HMW adiponectin levels were significantly lowest in the any-lipohypertrophy group and highest in the no-lipodystrophy group (p = 0.001). There were no significant differences in the levels of resistin among the three groups (p = 0.234). The prevalence of insulin resistance (p = 0.002) and prediabetes/diabetes (p |
| doi_str_mv | 10.1016/j.cyto.2020.155145 |
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Lipodystrophy is common in HIV-infected patients receiving protease inhibitors (PIs), stavudine, and zidovudine. Adipocytokines may be altered in lipodystrophy. We evaluated risk factors, adipocytokine levels, insulin resistance, and lipid profiles in HIV-infected adolescents with different lipodystrophy types.
A cross-sectional study was conducted in 80 perinatally HIV-infected adolescents receiving PI-based highly active antiretroviral therapy for ≥ 6 months. Patients underwent oral glucose tolerance tests and measurements of high-molecular-weight (HMW) adiponectin, leptin, resistin, insulin, and lipids. They were classified into 3 groups based on the clinical findings: no lipodystrophy, isolated lipoatrophy, and any lipohypertrophy (isolated lipohypertrophy or combined type).
Of the 80 patients (median age, 16.7 years), 18 (22.5%) had isolated lipoatrophy, while 8 (10%) had any lipohypertrophy (four with isolated lipohypertrophy, and four with the combined type). In a multivariate analysis, longer exposure to stavudine (OR: 1.03; 95% CI, 1.01–1.06; p = 0.005) and indinavir (OR: 1.03; 95% CI, 1.01–1.06; p = 0.012) were associated with lipoatrophy, while longer exposure to didanosine (OR: 1.04; 95% CI, 1.01–1.08; p = 0.017) and indinavir (OR: 1.10; 95% CI, 1.00–1.21; p = 0.045) were associated with any lipohypertrophy. Leptin levels were highest in the any-lipohypertrophy group and lowest in the isolated-lipoatrophy group (p = 0.013). HMW adiponectin levels were significantly lowest in the any-lipohypertrophy group and highest in the no-lipodystrophy group (p = 0.001). There were no significant differences in the levels of resistin among the three groups (p = 0.234). The prevalence of insulin resistance (p = 0.002) and prediabetes/diabetes (p < 0.001) were significantly highest in the any-lipohypertrophy group. Patients with lipoatrophy and those without lipodystrophy had comparable degrees of insulin resistance (p = 0.292). In multiple linear regression analysis, adjusted for age, sex, and waist-height ratio, HMW adiponectin levels were associated with Matsuda index (β = 0.5; p = 0.003) and quantitative insulin sensitivity check index (QUICKI) (β = 40.1; p = 0.010) and almost significantly associated with homeostatic model assessment of insulin resistance (HOMA-IR) (p = 0.054). Leptin and resistin levels were not associated with HOMA-IR, Matsuda index, or QUICKI (all p > 0.05).
Abnormal glucose metabolism and dysregulation of adipocytokines were common in the HIV-infected adolescents with lipohypertrophy and the combined type. Preventive screening for cardiovascular diseases caused by metabolic alterations should be routinely performed.</description><identifier>ISSN: 1043-4666</identifier><identifier>EISSN: 1096-0023</identifier><identifier>DOI: 10.1016/j.cyto.2020.155145</identifier><identifier>PMID: 32920318</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adipocytokines ; Adipokines - blood ; Adiponectin ; Adolescent ; Adolescents ; Adult ; Blood Glucose - metabolism ; Cross-Sectional Studies ; Female ; Highly active antiretroviral therapy ; HIV ; HIV Protease Inhibitors - administration & dosage ; HIV-1 - metabolism ; HIV-Associated Lipodystrophy Syndrome - blood ; HIV-Associated Lipodystrophy Syndrome - drug therapy ; Humans ; Insulin resistance ; Leptin ; Male ; Protease inhibitor ; Resistin</subject><ispartof>Cytokine (Philadelphia, Pa.), 2020-12, Vol.136, p.155145-155145, Article 155145</ispartof><rights>2020 Elsevier Ltd</rights><rights>Copyright © 2020 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-da3a116513c16ecec315cd52b9f772ab57ea6b128020c93b782165251fc735533</citedby><cites>FETCH-LOGICAL-c356t-da3a116513c16ecec315cd52b9f772ab57ea6b128020c93b782165251fc735533</cites><orcidid>0000-0002-4726-9360</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.cyto.2020.155145$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32920318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Santiprabhob, Jeerunda</creatorcontrib><creatorcontrib>Chokephaibulkit, Kulkanya</creatorcontrib><creatorcontrib>Khantee, Puttichart</creatorcontrib><creatorcontrib>Maleesatharn, Alan</creatorcontrib><creatorcontrib>Phonrat, Benjaluck</creatorcontrib><creatorcontrib>Phongsamart, Wanatpreeya</creatorcontrib><creatorcontrib>Lapphra, Keswadee</creatorcontrib><creatorcontrib>Wittawatmongkol, Orasri</creatorcontrib><creatorcontrib>Rungmaitree, Supattra</creatorcontrib><creatorcontrib>Tanchaweng, Surapong</creatorcontrib><creatorcontrib>Maturapat, Sirinoot</creatorcontrib><creatorcontrib>Lermankul, Watcharee</creatorcontrib><creatorcontrib>Tungtrongchitr, Rungsunn</creatorcontrib><title>Adipocytokine dysregulation, abnormal glucose metabolism, and lipodystrophy in HIV-infected adolescents receiving protease inhibitors</title><title>Cytokine (Philadelphia, Pa.)</title><addtitle>Cytokine</addtitle><description>•32.5% of PIs-treated adolescents had lipodystrophy: 10% with lipohypertrophy.•87.5% of adolescents with any lipohypertrophy had abnormal glucose metabolism.•Lipoatrophy had similar rate of abnormal glucose metabolism to non-lipodystrophy.•Abnormal adipocytokines were more profound in adolescents with any lipohypertrophy.•No difference in resistin level found among different types of lipodystrophy.
Lipodystrophy is common in HIV-infected patients receiving protease inhibitors (PIs), stavudine, and zidovudine. Adipocytokines may be altered in lipodystrophy. We evaluated risk factors, adipocytokine levels, insulin resistance, and lipid profiles in HIV-infected adolescents with different lipodystrophy types.
A cross-sectional study was conducted in 80 perinatally HIV-infected adolescents receiving PI-based highly active antiretroviral therapy for ≥ 6 months. Patients underwent oral glucose tolerance tests and measurements of high-molecular-weight (HMW) adiponectin, leptin, resistin, insulin, and lipids. They were classified into 3 groups based on the clinical findings: no lipodystrophy, isolated lipoatrophy, and any lipohypertrophy (isolated lipohypertrophy or combined type).
Of the 80 patients (median age, 16.7 years), 18 (22.5%) had isolated lipoatrophy, while 8 (10%) had any lipohypertrophy (four with isolated lipohypertrophy, and four with the combined type). In a multivariate analysis, longer exposure to stavudine (OR: 1.03; 95% CI, 1.01–1.06; p = 0.005) and indinavir (OR: 1.03; 95% CI, 1.01–1.06; p = 0.012) were associated with lipoatrophy, while longer exposure to didanosine (OR: 1.04; 95% CI, 1.01–1.08; p = 0.017) and indinavir (OR: 1.10; 95% CI, 1.00–1.21; p = 0.045) were associated with any lipohypertrophy. Leptin levels were highest in the any-lipohypertrophy group and lowest in the isolated-lipoatrophy group (p = 0.013). HMW adiponectin levels were significantly lowest in the any-lipohypertrophy group and highest in the no-lipodystrophy group (p = 0.001). There were no significant differences in the levels of resistin among the three groups (p = 0.234). The prevalence of insulin resistance (p = 0.002) and prediabetes/diabetes (p < 0.001) were significantly highest in the any-lipohypertrophy group. Patients with lipoatrophy and those without lipodystrophy had comparable degrees of insulin resistance (p = 0.292). In multiple linear regression analysis, adjusted for age, sex, and waist-height ratio, HMW adiponectin levels were associated with Matsuda index (β = 0.5; p = 0.003) and quantitative insulin sensitivity check index (QUICKI) (β = 40.1; p = 0.010) and almost significantly associated with homeostatic model assessment of insulin resistance (HOMA-IR) (p = 0.054). Leptin and resistin levels were not associated with HOMA-IR, Matsuda index, or QUICKI (all p > 0.05).
Abnormal glucose metabolism and dysregulation of adipocytokines were common in the HIV-infected adolescents with lipohypertrophy and the combined type. Preventive screening for cardiovascular diseases caused by metabolic alterations should be routinely performed.</description><subject>Adipocytokines</subject><subject>Adipokines - blood</subject><subject>Adiponectin</subject><subject>Adolescent</subject><subject>Adolescents</subject><subject>Adult</subject><subject>Blood Glucose - metabolism</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV Protease Inhibitors - administration & dosage</subject><subject>HIV-1 - metabolism</subject><subject>HIV-Associated Lipodystrophy Syndrome - blood</subject><subject>HIV-Associated Lipodystrophy Syndrome - drug therapy</subject><subject>Humans</subject><subject>Insulin resistance</subject><subject>Leptin</subject><subject>Male</subject><subject>Protease inhibitor</subject><subject>Resistin</subject><issn>1043-4666</issn><issn>1096-0023</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9PHCEYh0ljU63tF-jBcPTgbPkzMDuJF2O0mpj00vZKGHhnZWVgBcZkP0C_d5mseuwJAr_fk_d9EPpGyYoSKr9vV2Zf4ooRVh-EoK34gE4o6WVDCONHy73lTSulPEafc94SQnredZ_QMWc9I5yuT9DfK-t2ceE8uQDY7nOCzex1cTFcYD2EmCbt8cbPJmbAExQ9RO_yVD-Dxb6Wa6ekuHvcYxfw3f2fxoURTAGLtY0esoFQMk5gwL24sMG7FAvoCnPh0Q2uxJS_oI-j9hm-vp6n6Pftza_ru-bh54_766uHxnAhS2M115RKQbmhsvIMp8JYwYZ-7DqmB9GBlgNl62rE9Hzo1qymmaCj6bgQnJ-i8wO3zvA8Qy5qcnU-73WAOGfF2paJvu_FukbZIWpSzFXKqHbJTTrtFSVq0a-2atGmFv3qoL-Wzl758zCBfa-8-a6By0MA6pYvDpLKxkEwYF0VVJSN7n_8f57ImUw</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Santiprabhob, Jeerunda</creator><creator>Chokephaibulkit, Kulkanya</creator><creator>Khantee, Puttichart</creator><creator>Maleesatharn, Alan</creator><creator>Phonrat, Benjaluck</creator><creator>Phongsamart, Wanatpreeya</creator><creator>Lapphra, Keswadee</creator><creator>Wittawatmongkol, Orasri</creator><creator>Rungmaitree, Supattra</creator><creator>Tanchaweng, Surapong</creator><creator>Maturapat, Sirinoot</creator><creator>Lermankul, Watcharee</creator><creator>Tungtrongchitr, Rungsunn</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4726-9360</orcidid></search><sort><creationdate>202012</creationdate><title>Adipocytokine dysregulation, abnormal glucose metabolism, and lipodystrophy in HIV-infected adolescents receiving protease inhibitors</title><author>Santiprabhob, Jeerunda ; Chokephaibulkit, Kulkanya ; Khantee, Puttichart ; Maleesatharn, Alan ; Phonrat, Benjaluck ; Phongsamart, Wanatpreeya ; Lapphra, Keswadee ; Wittawatmongkol, Orasri ; Rungmaitree, Supattra ; Tanchaweng, Surapong ; Maturapat, Sirinoot ; Lermankul, Watcharee ; Tungtrongchitr, Rungsunn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-da3a116513c16ecec315cd52b9f772ab57ea6b128020c93b782165251fc735533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adipocytokines</topic><topic>Adipokines - blood</topic><topic>Adiponectin</topic><topic>Adolescent</topic><topic>Adolescents</topic><topic>Adult</topic><topic>Blood Glucose - metabolism</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Highly active antiretroviral therapy</topic><topic>HIV</topic><topic>HIV Protease Inhibitors - administration & dosage</topic><topic>HIV-1 - metabolism</topic><topic>HIV-Associated Lipodystrophy Syndrome - blood</topic><topic>HIV-Associated Lipodystrophy Syndrome - drug therapy</topic><topic>Humans</topic><topic>Insulin resistance</topic><topic>Leptin</topic><topic>Male</topic><topic>Protease inhibitor</topic><topic>Resistin</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Santiprabhob, Jeerunda</creatorcontrib><creatorcontrib>Chokephaibulkit, Kulkanya</creatorcontrib><creatorcontrib>Khantee, Puttichart</creatorcontrib><creatorcontrib>Maleesatharn, Alan</creatorcontrib><creatorcontrib>Phonrat, Benjaluck</creatorcontrib><creatorcontrib>Phongsamart, Wanatpreeya</creatorcontrib><creatorcontrib>Lapphra, Keswadee</creatorcontrib><creatorcontrib>Wittawatmongkol, Orasri</creatorcontrib><creatorcontrib>Rungmaitree, Supattra</creatorcontrib><creatorcontrib>Tanchaweng, Surapong</creatorcontrib><creatorcontrib>Maturapat, Sirinoot</creatorcontrib><creatorcontrib>Lermankul, Watcharee</creatorcontrib><creatorcontrib>Tungtrongchitr, Rungsunn</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cytokine (Philadelphia, Pa.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Santiprabhob, Jeerunda</au><au>Chokephaibulkit, Kulkanya</au><au>Khantee, Puttichart</au><au>Maleesatharn, Alan</au><au>Phonrat, Benjaluck</au><au>Phongsamart, Wanatpreeya</au><au>Lapphra, Keswadee</au><au>Wittawatmongkol, Orasri</au><au>Rungmaitree, Supattra</au><au>Tanchaweng, Surapong</au><au>Maturapat, Sirinoot</au><au>Lermankul, Watcharee</au><au>Tungtrongchitr, Rungsunn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adipocytokine dysregulation, abnormal glucose metabolism, and lipodystrophy in HIV-infected adolescents receiving protease inhibitors</atitle><jtitle>Cytokine (Philadelphia, Pa.)</jtitle><addtitle>Cytokine</addtitle><date>2020-12</date><risdate>2020</risdate><volume>136</volume><spage>155145</spage><epage>155145</epage><pages>155145-155145</pages><artnum>155145</artnum><issn>1043-4666</issn><eissn>1096-0023</eissn><abstract>•32.5% of PIs-treated adolescents had lipodystrophy: 10% with lipohypertrophy.•87.5% of adolescents with any lipohypertrophy had abnormal glucose metabolism.•Lipoatrophy had similar rate of abnormal glucose metabolism to non-lipodystrophy.•Abnormal adipocytokines were more profound in adolescents with any lipohypertrophy.•No difference in resistin level found among different types of lipodystrophy.
Lipodystrophy is common in HIV-infected patients receiving protease inhibitors (PIs), stavudine, and zidovudine. Adipocytokines may be altered in lipodystrophy. We evaluated risk factors, adipocytokine levels, insulin resistance, and lipid profiles in HIV-infected adolescents with different lipodystrophy types.
A cross-sectional study was conducted in 80 perinatally HIV-infected adolescents receiving PI-based highly active antiretroviral therapy for ≥ 6 months. Patients underwent oral glucose tolerance tests and measurements of high-molecular-weight (HMW) adiponectin, leptin, resistin, insulin, and lipids. They were classified into 3 groups based on the clinical findings: no lipodystrophy, isolated lipoatrophy, and any lipohypertrophy (isolated lipohypertrophy or combined type).
Of the 80 patients (median age, 16.7 years), 18 (22.5%) had isolated lipoatrophy, while 8 (10%) had any lipohypertrophy (four with isolated lipohypertrophy, and four with the combined type). In a multivariate analysis, longer exposure to stavudine (OR: 1.03; 95% CI, 1.01–1.06; p = 0.005) and indinavir (OR: 1.03; 95% CI, 1.01–1.06; p = 0.012) were associated with lipoatrophy, while longer exposure to didanosine (OR: 1.04; 95% CI, 1.01–1.08; p = 0.017) and indinavir (OR: 1.10; 95% CI, 1.00–1.21; p = 0.045) were associated with any lipohypertrophy. Leptin levels were highest in the any-lipohypertrophy group and lowest in the isolated-lipoatrophy group (p = 0.013). HMW adiponectin levels were significantly lowest in the any-lipohypertrophy group and highest in the no-lipodystrophy group (p = 0.001). There were no significant differences in the levels of resistin among the three groups (p = 0.234). The prevalence of insulin resistance (p = 0.002) and prediabetes/diabetes (p < 0.001) were significantly highest in the any-lipohypertrophy group. Patients with lipoatrophy and those without lipodystrophy had comparable degrees of insulin resistance (p = 0.292). In multiple linear regression analysis, adjusted for age, sex, and waist-height ratio, HMW adiponectin levels were associated with Matsuda index (β = 0.5; p = 0.003) and quantitative insulin sensitivity check index (QUICKI) (β = 40.1; p = 0.010) and almost significantly associated with homeostatic model assessment of insulin resistance (HOMA-IR) (p = 0.054). Leptin and resistin levels were not associated with HOMA-IR, Matsuda index, or QUICKI (all p > 0.05).
Abnormal glucose metabolism and dysregulation of adipocytokines were common in the HIV-infected adolescents with lipohypertrophy and the combined type. Preventive screening for cardiovascular diseases caused by metabolic alterations should be routinely performed.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>32920318</pmid><doi>10.1016/j.cyto.2020.155145</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-4726-9360</orcidid></addata></record> |
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| ispartof | Cytokine (Philadelphia, Pa.), 2020-12, Vol.136, p.155145-155145, Article 155145 |
| issn | 1043-4666 1096-0023 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adipocytokines Adipokines - blood Adiponectin Adolescent Adolescents Adult Blood Glucose - metabolism Cross-Sectional Studies Female Highly active antiretroviral therapy HIV HIV Protease Inhibitors - administration & dosage HIV-1 - metabolism HIV-Associated Lipodystrophy Syndrome - blood HIV-Associated Lipodystrophy Syndrome - drug therapy Humans Insulin resistance Leptin Male Protease inhibitor Resistin |
| title | Adipocytokine dysregulation, abnormal glucose metabolism, and lipodystrophy in HIV-infected adolescents receiving protease inhibitors |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-04T13%3A49%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Adipocytokine%20dysregulation,%20abnormal%20glucose%20metabolism,%20and%20lipodystrophy%20in%20HIV-infected%20adolescents%20receiving%20protease%20inhibitors&rft.jtitle=Cytokine%20(Philadelphia,%20Pa.)&rft.au=Santiprabhob,%20Jeerunda&rft.date=2020-12&rft.volume=136&rft.spage=155145&rft.epage=155145&rft.pages=155145-155145&rft.artnum=155145&rft.issn=1043-4666&rft.eissn=1096-0023&rft_id=info:doi/10.1016/j.cyto.2020.155145&rft_dat=%3Cproquest_cross%3E2442599958%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2442599958&rft_id=info:pmid/32920318&rft_els_id=S1043466620301617&rfr_iscdi=true |