1st International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 26–28 June 1999 - San Diego, CA, USA

CLINICAL AND LABORATORY CHARACTERISTICS OF LIPODYSTROPHY IN A FRENCH COHORT OF HIV-INFECTED PATIENTS TREATED WITH PROTEASE INHIBITORS

Antiviral Therapy 1999; 4(Suppl. 2):34 (abstract no. 12)

W Rozenbaum, S Gharakhanian, Y Salhi, N Adda, T Nguyen, C Vigouroux and J Capeau
Rothschild Hospital, Paris, France

OBJECTIVE: A cross-sectional study was carried out to determine clinical and laboratory abnormalities in HIV-infected patients treated with HAART with the relevant risk factors as well as to contribute to a case definition.

METHODS: Patients receiving PI for longer than 3 months underwent clinical evaluation of clinical signs known to be related to the lipodystrophy syndrome, anthropometric measures, testing for fasting triglycerides, cholesterol and 75 g glucose oral tolerance and corresponding insulinaemia.

RESULTS: Six hundred and twenty-four patients (84% male, 16% female) were consecutively evaluated from July to November 1998 in the Rothschild Hospital AIDS Clinic. Patients were aged 40±9 years, with an AIDS-defining event in 31%. At evaluation, 69% had an HIV RNA below 500 copies/ml, CD4 365±220 cells/mm³ and duration of PI was 18±9 months, mostly indinavir (66%). The most frequent manifestations were increased abdominal wall thickness (48%), phlebomegaly (48%), increased waist size (43%), atrophy of lower limbs (41%), facial atrophy (41%), buttock atrophy (38%) and atrophy of upper limbs (27%). Only 16% had none of the clinical lipodystrophy-related manifestations. Two mutually exclusive clinical subtypes could be identified: atrophic (14%) and truncal adiposity (15%), remaining patients were of mixed or heterogeneous subtypes. BMI values were identical within the groups. Skinfold thickness as well as waist size was significantly different within the groups but not the waist/hip ratio. Duration of treatment was statistically longer in the atrophic subtype. Impaired glucose regulation was noted in 27% of patients and diabetes in 7%. Abnormal insulin values were noted in 42% of patients. Insulin- and glucose-related abnormalities were statistically lower in the clinically normal group (29% versus 43%). Cholesterol levels were >6.2 mmol/l in 34% and triglyceride were >1.7 mmol/l in 54%. Those levels were significantly lower in the normal and truncal adiposity groups.

CONCLUSIONS: HIV-related lipodystrophy syndrome includes a variety of clinical and biological manifestations, which can be included in a case definition. Different subtypes can be distinguished. The natural history of this syndrome deserves prospective follow up.

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