4th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 22-25 September 2002, San Diego, CA, USA

EFFECT OF STAVUDINE, ZIDOVUDINE AND HIV PROTEASE INHIBITOR THERAPY ON SUBCUTANEOUS LEG FAT WASTING IN HIV-INFECTED MALES - A LONGITUDINAL STUDY

Antiviral Therapy 2002; 7:L18 (abstract 28)

D Nolan, I James, E McKinnon and S Mallal
Centre for Clinical Immunology and Biomedical Statistics, Royal Perth Hospital and Murdoch University, Perth, Western Australia

OBJECTIVE: To determine the relative effects of stavudine, zidovudine and protease inhibitor (PI) therapy on the longitudinal course of leg fat wasting in treatment-naïve male HIV-infected patients receiving their first highly active antiretroviral therapy (HAART).

DESIGN: Prospective, longitudinal study of an observational cohort.

PATIENTS/MEASUREMENTS: White male ART-naïve patients in the Western Australian HIV Cohort Study who had at least two sequential DEXA scans whilst undergoing a first HAART triple therapy regimen containing either stavudine or zidovudine. The group consisted of 53 patients, of whom 27 received stavudine and 26 zidovudine. Thirty-three patients received PI therapy, 17 of the stavudine and 16 of the zidovudine cases. Patients had between two and six DEXA scans, with an average of 3.1/patient. Other variables included in analyses were age at commencement of HAART, BMI, baseline CD4 count and presence of baseline AIDS.

STATISTICAL METHODS: Longitudinal profiles of leg fat percentage, ratio of leg fat weight to BMI and ratio of leg fat weight to whole body weight were analysed from commencement of HAART. Analyses were based on a non-linear mixed effects model which took account of the repeated measurements on individuals and allowed both individual variation in, and long term levelling of, the average profiles.

RESULTS: Both stavudine and zidovudine groups averaged approximately 22% leg fat at commencement of HAART. The population average post-HAART leg percentage in patients including stavudine dropped exponentially to approximately 13% after 2 years. By contrast, the population average for the zidovudine treated group levelled off after 2 years at approximately 19% leg fat, significantly higher than for stavudine (P<0.005). We found no significant effect of PI vs non-PI treatment in the long-term levels of percentage leg fat. Similar findings were obtained for the ratios of leg fat weight to BMI and to whole body weight.

CONCLUSIONS: In this study the use of stavudine in the first HAART regimen was associated with more rapid fat loss in the legs compared with zidovudine. The findings of this longitudinal analysis of sequential DEXA scans is in keeping with the previous study in this cohort which examined the time to onset of clinically apparent subcutaneous fat wasting.

Presenting author: D Nolan

2002-09-22
28

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