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

LIPODYSTROPHY SYNDROME IN PATIENTS WITH PRIMARY HIV INFECTION ON LONG TERM ANTIRETROVIRAL THERAPY

Antiviral Therapy 1999; 4(Suppl. 2):59 (abstract no. 46)

J Miller¹, D Smith², P Grey², S Emery¹, A Carr³, J Anderson⁴, R McFarlane⁴, W Genn⁴ and DA Cooper^1
1National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney; ²Community HIV Research Network, University of New South Wales, Sydney; ³St Vincent's Hospital, Sydney; and ⁴National Lipodystrophy Study Group, Australia

INTRODUCTION: Lipodystrophy has been extensively described in patients with advanced disease on long-term PI therapy. There is debate whether these features are related predominantly to long-term PI or nucleoside analogue (NRTI) toxicity or to perturbations in the natural course of HIV infection. If this phenomenon were related to the duration of antiretroviral (ARV) therapy then one would expect similar manifestations in patients with primary HIV infection (PHI) on ARV therapy.

METHODS: A cross-sectional survey was undertaken on a cohort of PHI patients receiving ARV therapy. Data describing duration of ARV therapy, type of therapy, patient and physician reported body shape changes, blood chemistry and body composition were collected.

RESULTS: 31 patients with PHI (seroconversion <30 months prior) were studied. All were homosexual men (mean age 39). Mean CD4 cell count was 807 cells/mm³ (range 350-1570), 28/31 patients had plasma RNA <400 copies/ml. Therapy included: nelfinavir plus 2 RTIs (15 patients), indinavir plus 2 RTIs (7), amprenavir plus 3 RTIs (1) and nevirapine plus 2 RTIs (2). The average duration of PI therapy was 14.2 months (range 0-27). 14/31 patients reported signs of fat redistribution, 7/14 reporting changes in three or more sites. In contrast, the physician's assessment of these 14 patients identified LD in only 7/14 and fewer affected sites were identified. 7/14 patients reported peripheral fat loss and truncal obesity, 3/14 reported peripheral fat loss only, and 4/14 reported truncal obesity alone. The mean length of PI treatment for those reporting signs of LD was 18.3 months compared to 9 months for those who did not report fat redistribution. Additionally, 2/14 patients reporting fat redistribution were PI-naïve, both receiving nevirapine/lamivudine/stavudine. patients were hyperlipidaemic.

CONCLUSIONS: Features of LD syndrome are common in patients with PHI treated with antiretroviral therapy. There is an association with duration of PI therapy but can occur in patients who are PI-naïve.

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