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

FOLLOW-UP OF LIPODYSTROPHY AND METABOLIC ALTERATIONS IN THE ANRS APROCO-COPILOTE COHORT STUDYING HIV-INFECTED PATIENTS INITIATED WITH PROTEASE INHIBITORS IN 1997 AND 1998: RELATION TO ADIPONECTIN, LEPTIN AND TRIGLYCERIDES LEVELS AND TO TNF POLYMORPHISMS

Antiviral Therapy 2007; 12(Suppl. 2):L30 (abstract no. P-16)

JP Bastard¹, E Pereira², J Reynes³, M Kim¹, C Tse¹, S Herson⁴, M Maachi¹, M Hellet², JL Ecobichon⁵, F Raffi⁶, G Chene² and J Capeau^1
1Inserm U680, Universite-Paris6, Hopital Tenon AP-HP, Paris, France; ²InsermU593, ISPED, Bordeaux, France; ³CHU Montpellier, Montpellier France; ⁴Hopital Pitié-Salpétrière, AP-HP, Paris, Fance; ⁵Hópital Bichat, AP-HP, Paris, France; ⁶CHU Nantes, Nantes, France

AIM: To evaluate the long-term contribution of adipokine, metabolic parameters and TNF polymorphisms to lipodystrophy and metabolic abnormalities in ART-treated patients

METHODS: Patients were evaluated 12 or 20 months (phase 1, n=343), 24 or 36 months (phase 2, n=338) and 48 months (phase 3, n=239) after initiation of a treatment with PIs. Lipodystrophy was clinically recorded; metabolic parameters, insulin, adipokines and cytokines were determined at any phase. TNF polymorphisms -238 and 308 were investigated. In addition, clinical and metabolic parameters were assessed up to 72 months.

RESULTS: Between phase 1 and 3, mean body mass index (BMI) was low and remained unmodified (22.5–22.8 kg/m²). The prevalence of lipodystrophy increased (66–73%) as did the prevalence of lipoatrophy (47–63%, isolated or associated with lipohypertrophy). Median leptin level increased from 1.8 to 2.5 ng/ml, and was related to sex, BMI, insulin resistance and adiponectin level. Median adiponectin level decreased from 4.4 to 3.0 µg/ml, and was inversely related to insulin resistance, triglycerides, glycaemia, sTNFR1 and CRP. No association between TNF-238 and -308 polymorphisms, and lipodystrophy, metabolic parameters, adipokine and cytokine levels was observed. In multivariate analyses, the occurrence of lipodystrophy was related to adiponectin (odds ratio, OR=0.88 for 1 µg/ml), triglycerides (OR=1.58 for 10 mg/dl) and the duration of infection (OR=1.10 per year). The occurrence of lipoatrophy was related to age (OR=2.01 for 10 years), adiponectin (OR=0.83 for 1 µg/ml), triglycerides (OR=1.31 for 10 mg/dl), duration of infection (OR=1.11 per year) and BMI (OR=0.79 per kg/m²). A metabolic syndrome, defined according to NCEP-ATPIII 2005, was present in 15–20% of patients at each phase up to 72 months, whereas the prevalence of diabetes increased from 6.7% to 11.2%. A metabolic syndrome was present in 47–69% of diabetic and 15–19% on nondiabetic patients.

CONCLUSION: The prevalence of lipoatrophy increased with time in patients initiated with PI in 1997–1998. Its presence was positively related to age, duration of infection and triglycerides, and negatively to BMI and adiponectin. TNF polymorphisms were not associated with lipodystrophy and metabolic alterations. The prevalence of a metabolic syndrome was unchanged during evolution while that of diabetes increased.

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2007-07-24
P-16

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