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

CONSIDERATIONS IN THE DEVELOPMENT OF A CASE DEFINITION FOR HIV/HAART-ASSOCIATED LIPODYSTROPHY SYNDROME

Antiviral Therapy 1999; 4(Suppl. 2):44 (abstract no. 21)

J Falutz and D Turcot
Montreal General Hospital, Montreal, Quebec, Canada

BACKGROUND: A case definition for HIV/HAART-associated lipodystrophy (HAL) does not exist yet. Owing to the varied clinical manifestations and possible association with dyslipidaemia and insulin resistance, a clear distinction between cases and controls based on clinical and laboratory features is needed.

OBJECTIVES: Assess factors determining clinical/laboratory similarities and differences between HAL cases and controls.

DESIGN: Patients (140 males, 30 females) were evaluated clinically for HAL. Fasting lipid profiles, C-peptide, insulin and glucose levels, in addition to CD4 counts and HIV RNA viral loads (VL) were determined.

RESULTS: Men with HAL (n=77) were more likely than men without HAL (n=63) to have abnormal lipid profiles (P=0.04). Men with HAL (n=27) had similar C-peptide and insulin levels as men without HAL (n=19). Men (n=21) on long-term saquinavir HAART, with a mean VL of 1400 copies/ml, were less likely (P=0.03) to develop HAL than a comparable group of men (n=23) on indinavir HAART. Males on long-term saquinavir with HAL (n=5) had similar lipid profiles to males on long-term saquinavir without HAL (n=16). Lipid profiles were more likely to be abnormal in males with HAL on indinavir than in males with HAL on saquinavir. Females with HAL (n=17) had similar CD4 counts, VL and lipid profiles compared to females without HAL (n=13); were more likely to have normal lipid profiles than males with HAL (P=0.0003); but were more likely than males with HAL to have truncal obesity (P=0.0001) and less likely to have peripheral lipoatrophy (P=0.02).

CONCLUSIONS: Given the gender and HAART profile-based differences and similarities in clinical and laboratory features in HAL cases and controls, these variables among others, need to be considered in the development of a case definition.

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