9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 19-21 July 2007, Sydney, Australia

FACTORS ASSOCIATED WITH LOW LIMB FAT IN A COHORT OF ZIDOVUDINE-TREATED SUBJECTS

Antiviral Therapy 2007; 12(Suppl. 2):L28 (abstract no. P-12)

G Moyle¹, M Fisher² and SWEET Study Group
¹Chelsea & Westminster Hospital, London, UK; ²Brighton General Hospital, Brighton, UK

BACKGROUND: Cross-sectional cohort studies established the association between stavudine use and limb fat loss/lipoatrophy. Although limb fat loss has been associated with zidovudine use, the factors associated with low limb fat during zidovudine therapy are less well investigated.

METHODS: Subjects enrolling in a 48-week switch from Combivir + efavirenz to truvada + efavirenz were offered DEXA scanning at baseline. Subjects were required to have HIV-RNA <50 copies/ml and be stable on therapy for ≥6 months. Subjects were not selected on the basis of any morphological assessments. Low limb fat was defined as <5 kg based on previous DEXA studies. Clinical, demographic and therapy-related factors were examined in logistic (defining limb fat dichotomously <5 kg yes/no) and linear (using limb fat as a continuous variable) regression models to examine the factors associated with low limb fat and cross validate observations. Sensitivity analyses addressed affects of BMI, ethnicity, gender and prior stavudine use.

RESULTS: Two-hundred and fifty subjects entered the main study with 99 included in the DEXA sub-study analysis. DEXA sub study subjects had similar baseline characteristics to the overall population. Baseline demographics for the DEXA sub-study included 88% male, 76% white, median age 43 years (IQR 37–49), median BMI 24 (IQR 22–27), median prior zidovudine/Combivir use 2.9 years (IQR 1.9–4.5). Only 13% of participants had previously received stavudine. The median limb fat was 4.9 kg. Multivariable models identified BMI and duration of zidovudine use as significantly associated with low limb fat. Per year of zidovudine exposure was associated with 40% increase in the odds of low limb fat (OR 1.4, 95% CI: 1.09–1.77). An increase in 1 unit of BMI reduced the odds of low limb fat by 30% (OR 0.7, 95% CI: 0.59–0.84). Results were similar when only males, only whites and those with no prior stavudine were considered. The proportion of subjects with low limb fat by quartile of zidovudine exposure duration was 0.7–1.8 years 38%, 1.9–2.9 years 38%, 3.0–4.5 years 63%, 4.6–9.9 years 67%.

CONCLUSIONS: Lower BMI and longer duration of zidovudine exposure were each independently associated with lower limb fat and greater odds of low limb fat in a cohort of Combivir + efavirenz-treated subjects.

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2007-07-24
P-12

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