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8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIVSan Francisco, California - September 24 - 26, 2006 |
LONGITUDINAL ALTERATION IN BODY SHAPE AND METABOLISM ON NNRTI-HAART IN SOUTH INDIA
Antiviral Therapy 2006; 11:L20 (abstract no. 27)
S Saghayam1, N Kumarasamy1, A Cecelia1, S Solomon1, P Balakrishnan1, G Shivaji2, T Flanigan3, K Mayer3 and C Wanke4
1YRG Centre for AIDS Research and Education, Chennai, India; 2Women’s Christian College, Chennai, India; 3Miriam Hospital, Brown University, Providence, RI, USA; 4Tufts University School of Medicine, Boston, MA, USA
BACKGROUND: Use of generic NNRTI-HAART is rising in South India, where there is high prevalence of CVD & diabetes. We studied the body shape and metabolic changes at 0–6 and 6–12 months between two NNRTI regimens since few data exist from developing countries.
METHODS: All were treatment naïve; 24 initiated EFV (42% d4T) and 15 NVP (73% d4T). Anthropometry, BIA, fasting lipids, glucose (FBS), CD4 and viral load (VL) were done at 0, 6 and 12 months. Wilcoxon test compared 2 time points within each group. Data are expressed as mean change.
RESULTS: Baseline: Mean ages in EFV and NVP groups were 32 and 35 years; 77% of cohort was male. Groups were comparable. Median CD4 and VL for EFV/NVP: 114/167 cells/mm3, 381000/259000 copies/ml. BMI (18.9 kg/m2) was low normal for S India. <15% had TG >150 mg/dl. HDL was low in both groups (<35 mg/dl; 67% – EFV, 60% – NVP). The initial 6 months response to NNRTI-HAART showed all circumferences increased; body shape changes were symmetrical. Lipids increased on EFV but not on NVP and a striking increase in HDL on EFV (<35 mg/dl; 8% – EFV, 40% – NVP). FBS increased in both groups. During the follow-up 6 months, all circumferences, triceps skinfold (TSF) and fat were lower on EFV and NVP. Midarm and hip circumferences, TSF and fat decreased on EFV and only hip circumference decreased on NVP. TC, LDL-c was lower in both groups. Interestingly HDL decreased (<35 mg/dl; 25% – EFV, 67% – NVP). TG showed an increase (>150 mg/dl – 42%) on EFV. FBS continued to increase on EFV and decreased on NVP.
CONCLUSION: The initial 6 months response differed significantly from the follow-up 6 months response. The beneficial effect of NNRTI-HAART seen in the initial phase seems to be wearing off during the follow-up. Careful monitoring of these patients is warranted to prevent adverse effects of body shape and lipid changes with longer time on NNRTI.
Table 1. (Abstract 27)
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| EFV (n=24) | NVP (n=15) | |||||||
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| Parameters | 0–6 months | 6–12 months | 0–6 months | 6–12 months | ||||
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| BMI | 0.7 ±1.1 | 0.4 ±1.2 | 1.6 ±1.4 | 0.2 ±1.6** | ||||
| MAC | 1.3 ±1.9 | -1.0 ±2.4** | 1.5 ±2.0 | 1.0 ±1.6* | ||||
| Waist | 3.3 ±3.4 | 0.4 ±2.9** | 3.4 ±3.2 | 0.6 ±4.3* | ||||
| Hip | 1.5 ±3.2 | -0.3 ±3.8 | 4.3 ±2.3 | -1.8 ±3.4** | ||||
| Thigh | 2.6 ±2.3 | 0.9 ±2.8* | 4.1 ±2.6 | 0.2 ±3.5** | ||||
| TSF | 0.6 ±4.3 | -1.3 ±6.3 | 3.9 ±4.1 | 0.2 ±7.8 | ||||
| TC | 35.3 ±31.9 | -3.0 ±28.2** | 9.2 ±28.3 | 4.9 ±24.7 | ||||
| HDL-c | 19.7 ±11.8 | -8.4 ±8.6** | 3.8 ±11.9 | -4.3 ±14.4 | ||||
| LDL-c | 21.6 ±27.6 | 12.3 ±23.4 | 17.7 ±26.8 | 15.2 ±20.2 | ||||
| TG | 14.9 ±74.3 | 45.8 ± 69.6 | 22.8 ± 51.1 | 5.0 ±67.7 | ||||
| FBS | 2.4 ±9.4 | 2.4 ±9.7 | 5.5 ±7.0 | -1.6 ±7.5** | ||||
| Body fat | 1.3 ±2.4 | -0.04 ±2.2 | 1.3 ±2.6 | 0.5 ±2.9 | ||||
| CD4 | 125 ±60 | 61 ±75** | 142 ±65 | 43 ±184* | ||||
| <400 96% | 88% | 67% | 47% | |||||
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| **P<0.05; *P<0.1 | ||||||||
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2006-09-24
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