A 45-year-old man with HIV on ART including ritonavir-boosted lopinavir develops lipodystrophy, hyperlipidemia, and insulin resistance. Which specific protease inhibitor effect is primarily responsible for this metabolic syndrome?

• A Inhibition of HIV-1 protease cleavage of Gag-Pol polyprotein
• B Binding to LDL receptor-related protein causing hyperlipidemia
• C Inhibition of GLUT4 glucose transporter in adipocytes ✓
• D Inhibition of CYP3A4-mediated steroid metabolism

Explanation

Protease inhibitors cause metabolic syndrome partly by inhibiting GLUT4-mediated glucose uptake in adipocytes, leading to insulin resistance, hyperlipidemia, and peripheral lipodystrophy. Gag-Pol cleavage inhibition is the antiviral mechanism, not the cause of metabolic toxicity. LRP binding is not the primary mechanism. CYP3A4 inhibition is caused by ritonavir, not the metabolic syndrome itself.

Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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