8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV San Francisco, California - September 24 - 26, 2006

THE PREVALENCE AND METABOLIC CONSEQUENCES OF ANTIRETROVIRAL-ASSOCIATED LIPODYSTROPHY IN A POPULATION OF HIV-INFECTED AFRICAN SUBJECTS

Antiviral Therapy 2006; 11:L20 (abstract no. 28)

E Mutimura¹, A Stewart² and NJ Crowther^3
1Kigali Health Institute, Kigali, Rwanda; ²Department of Physiotherapy, University of the Witwatersrand, Johannesburg; and ³Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand, Johannesburg, South Africa

BACKGROUND: The use of highly active anti-retroviral therapy (HAART) for HIV treatment is increasing in sub-Saharan Africa. However, the prevalence of HAART-related lipodystrophy within this population is unknown. Therefore, the aim of this study was to determine the prevalence and metabolic consequences of antiretroviral-associated lipodystrophy in a population of HIV positive African subjects.

METHODS: Lipodystrophy prevalence was measured in 571 Rwandans who had received HAART (81.6% of subjects received nevirapine/lamivudine/stavudine) for at least 6 months. Selected metabolic parameters of 100 HIV positive adults with lipodystrophy, 50 HIV positive, non-lipodystrophic adults and 50 HIV negative volunteers were measured. Statistical analyses were done by normalization of variables via log or by root square values across 3 groups via ANOVA. A post hoc analysis to determine differences in paired means was done by either Kruskal-Wallis ANOVA or Mann–Whitney U test.

FINDINGS: Lipodystrophy was observed in 34% of the total study cohort with a prevalence of 69.8% in those receiving HAART for longer than 17 months. Lipodystrophic patients had significantly higher waist circumferences (86.3 ±6.0 versus 75.9 ±6.1 cm: P<0.0005) than the non-lipodystrophic group. Total cholesterol concentrations (expressed as median [interquartile range]) were higher in the lipodystrophic group (3.60 [1.38] mmol/l) than the HIV positive, non-lipodystrophic (3.19 [0.65] mmol/l; P<0.005) and HIV negative (3.13 [0.70] mmol/l; P<0.0005) groups. Impaired fasting glucose (fasting glucose >5.6 mmol/l) was observed in 18% of lipodystrophic subjects, 16% of non-lipodystrophic subjects and 2% (P<0.01 and P<0.05 versus lipodystrophic and non-lipodystrophic groups, respectively) of HIV negative subjects.

INTERPRETATION: Lipodystrophy is common in African subjects receiving HAART and is characterized by increased waist circumference and raised blood glucose and cholesterol concentrations. Glucose levels are also raised in non-lipodystrophic, HIV positive subjects suggesting that body fat re-distribution is not the major contributor to glucose intolerance in HAART-treated HIV positive patients. Thus, to prevent the progression of HIV-related metabolic complications to overt cardiovascular disease and T2DM risks in HIV positive individuals, there is a need to monitor anthropomorphic and metabolic parameters, mainly in countries where there are minimal health resources and HIV prevalence is highest in the world.

Download PDF of this abstract.

2006-09-24
28

Copyright © 2006 - International Medical Press Ltd. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.