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

PREVALENCE OF LIPODYSTROPHY AND RELATION WITH CLINICAL, ANTHROPOMETRIC DATA AND TREATMENT, AQUITAINE COHORT, 1999

Antiviral Therapy 1999; 4(Suppl. 2):40 (abstract no. 16)

V Daucourt^1,2, R Thiébaut^1,3, P Mercié^2,3, D Malvy^2,3, D Neau^2,3, F Bonnal^2,3, C Marimoutou^1,2 and F Dabis¹ for the Groupe d'Epidémiologie du SIDA en Aquitaine^1,2 (GECSA)
¹INSERM U330, Université Victor Segalen Bordeaux 2, Bordeaux; ²CISIH, Centre Hospitalier Universitaire de Bordeaux;and ³Service de Médecine Interne, Centre Hospitalier Universitaire de Bordeaux,France

BACKGROUND: Since 1996, lipodystrophy has been described in HIV-infected patients particularly when treated by HAART with a PI.

OBJECTIVES: To estimate the prevalence of lipodystrophy (LD) in their different clinical presentations and to look for associated factors in a multirisk cohort of HIV-infected patients of both genders receiving different antiretroviral (ARV) regimens.

DESIGN: Cross-sectional survey of all patients of the Aquitaine Cohort attending or outpatient of seven participating hospital units over 1 month. Clinical examination distinguished peripheral fat wasting (LD1) of face or limbs with prominence of subcutaneous veins from peripheral adiposity (LD2) defined as peri-abdominal adiposity, buffalo neck, enlargement of breasts and mixed syndrome (with also LD1 characteristics). Positive virological response was defined by two consecutive undetectable plasma HIV RNA tests after initiation of ARV treatment.

RESULTS: Two hundred and twenty (37.9%) of the 581 studied patients were LD-positive (95% CI: 33.9-41.8); 90 (15.5%) LD1 and 130 (22.4%) LD2, including 57 mixed syndromes. LD patients were older than LD-negative patients (mean age 42 versus 39 years, P<0.01) while sex ratio, HIV transmission categories, plasma RNA level, CD4 count and BMI did not differ. LD patients were more frequently at AIDS stage (40 versus 20%, P<0.001), received more HAART with PI (75 versus 53%) with a median duration of treatment of 783 versus 539 days (P=0.01). A positive virological response was more frequent in LD patients (55 versus 46%, P=0.05). Age, HIV transmission category, clinical stage, CD4 count, plasma RNA level and ARV treatment were comparable in LD1 and LD2 patients. LD2 patients were more frequently women (32 versus 18%, P<0.03), had a higher BMI (23.6 versus 21.1, P<0.0001) and a higher waist to hip ratio (0.94 versus 0.91, P<0.001).

CONCLUSIONS: Our systematic approach allows us to conclude there is a high frequency of clinically defined LD including among patients not treated with PIs. LDs are associated with important anthropometric modifications, in particular for patients presenting peripheral adiposity or mixed syndromes.

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