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

LIPODYSTROPHY, GLUCOSE AND LIPID METABOLISM DYSFUNCTIONS, AQUITAINE COHORT, 1999

Antiviral Therapy 1999; 4(Suppl. 2):41 (abstract no. 17)

R Thiébaut^1,2, V Daucourt^1,3, D Malvy^1,2, N Bernard^2,3, S Farbos⁴, J Ceccaldi⁵, P Morlat^2,3 and JM Ragnaud^2,3 for the Groupe d'Epidémiologie Clinique du Sida en Aquitaine^1,3 {GECSA}
¹INSERM U330, Université Victor Segalen Bordeaux 2, Bordeaux; ²Service de Médecine Interne, Centre Hospitalier Universitaire de Bordeaux, France; ³CISIH, Centre Hospitalier Universitaire de Bordeaux, France; ⁴Service de Médecine Interne, Centre Hospitalier de Bayonne, France; and ⁵Service de Médecine Interne, Centre Hospitalierde Libourne, France

BACKGROUND: Lipodystrophy (LD) described since 1996 in HIV-infected patients treated with HAART are frequently associated to glucose and lipid (GL) metabolism abnormalities.

OBJECTIVES: To study the association between the different clinical presentations of LD and GL metabolism in a multirisk cohort of HIV-infected patients of both genders with different antiretroviral (ARV) regimens.

DESIGN: Systematic cross-sectional survey of patients of the Aquitaine Cohort attending in- or outpatient hospital units over 1 month. Clinical examination distinguished peripheral fat wasting (LD1) of the face or limbs with prominence of subcutaneous veins from peripheral adiposity (LD2), defined as peri-abdominal adiposity, buffalo neck, mammary hypertrophy, gynaecomastia and mixed syndrome (with also LD1 characteristics). Patients were considered to have hyperinsulinaemia (HI), hypertriglyceridaemia (HTG) or hypercholesterolaemia (HC) if their plasma measurements were >20 µIU/ml, >1.8 mmol/l or >0.7 mmol/l, respectively. HOMA ratio was calculated as (insulinaemia↔glycaemia/22.5) and insulin resistance was defined by a waist to hip ratio >1.0 for men and 0.8 for women.

RESULTS: Two hundred and twenty (37.9%) of the 581 included patients were LD-positive, 165 of them under PI regimen; 90 were LD1 and 130 LD2, including 57 mixed syndrome. 55.0% of the LD patients presented at least one abnormality in glucose or lipid metabolism versus 39% in the LD-negative group (P<0.001).HI was more frequent in LD-positive patients (17 versus 6%, P<0.01) as well as HTG (43 versus 13%, P<0.001) and IR (34 vs 25%, P=0.03), but HC was not. Mean HOMA ratio was higher in the LD group (4.0 versus 2.4, P<0.001). Diabetes prevalence was 3% in both groups. Prevalence of glucose (IR) or lipid (HC, HTG) metabolism was higher in LD2 (60%) than in LD1 (43%, P<0.01).

CONCLUSIONS: Lipid and glucose metabolism abnormalities are more frequent in LD patients (HI, IR, HTG) with various ARV regimens and are particularly frequent in patients presenting single or mixed peripheral adiposity.

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