Glucose production pathways by 2 H and 13 C NMR in patients with HIV‐associated lipoatrophy

Patients with HIV taking protease inhibitors were selected for the presence (five subjects) or absence (five subjects) of lipoatrophy. Following an overnight fast, subjects were given oral 2 H 2 O in divided doses (5 mL/kg body water), [U‐ 13 C 3 ] propionate (10 mg/kg), and acetaminophen (1000 mg). Glucose (from plasma) or acetaminophen glucuronide (from urine) were converted to monoacetone glucose for 2 H NMR and 13 C NMR analysis. The fraction of plasma glucose derived from gluconeogenesis was not significantly different between groups. However, flux from glycerol into gluconeogenesis relative to glucose production was increased from 0.20 ± 0.13 among subjects without lipoatrophy to 0.42 ± 0.12 ( P < 0.05) among subjects with lipoatrophy, and the TCA cycle contribution was reduced. Lipoatrophy was associated with an abnormal profile of glucose production as assessed by 13 C and 2 H NMR of plasma and urine. Magn Reson Med 51:649–654, 2004. Published 2004 Wiley‐Liss, Inc.