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

CASE REPORT OF LIPODYSTROPHY OBSERVATIONS IN PATIENTS NAÏVE OF PROTEASE INHIBITOR TREATMENT, AQUITAINE COHORT, 1999

Antiviral Therapy 1999; 4(Suppl. 2):42 (abstract no. 18)

P Mercié^1,2, D Malvy^2,3, V Daucourt^1,3, H Dutronc^1,2, D Lacoste^1,2, M Dupon^1,2, JL Pellegrin^1,2 and R Thiebaut^2,3 for the Groupe d'Epidémiologie du SIDA en Aquitaine^1,3 {GECSA}
¹CISIH, Centre Hospitalier Universitaire de Bordeaux; ²Service de Medecine Interne, Centre Hospitalier Universitaire de Bordeaux; ³INSERM U330, Université Victor Segalen Bordeaux 2, Bordeaux; and ⁴Service de Médecine Interne, Centre Hospitalier de Bayonne, France

BACKGROUND: Lipodystrophy (LD) is commonly reported in HAART patients treated with PIs.

OBJECTIVES: To describe LD in PI-naïve patients.

DESIGN: Systematic cross-sectional survey of patients of the Aquitaine Cohort 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 LDl characteristics).

RESULTS: Two hundred and twenty of the 581 included patients presented LD. Thirty one of them were naïve of PI. In those 31 patients, mean age was 43 years (SD: 11 years), 69% were males, 34% homosexuals, 31 % heterosexuals, 25% IVDUs, 6% blood recipients; 47% were asymptomatic and 19% at AIDS stage. Their median CD4 count and HIV RNA level were 437 cells/mm³ and 1335 copies/ml, respectively. Mean body mass index (BMI) was 23.9 kg/m² (SD 5.3). Thirty percent presented hypertriglyceridaemia (>1.8 mmol/l), 14% hypercholesterolaemia, 25 % hyperinsulinaemia and 37% insulin-resistance profile (waist to hip ratio >1 for men and >0.8 for women). Fourteen were LDl and 17 LD2 (six with a mixed syndrome). Current antiretroviral treatment was lamivudine monotherapy (1), two NRTIs (22), 1 NRTI and 1 NNRTI (1), 2 NRTIs and 1 NNRTI (5) and three had discontinued antiretroviral treatment. Ten patients were naïve for lamivudine, 12 for stavudine and four for both.

CONCLUSIONS: LD can be observed in a substantial number of patients naïve of PI. The implication of lamivudine and stavudine in LD recently suggested was not confirmed in our study, in which LD was observed in patients treated with many different antiretroviral combinations.

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