Lipodystrophy-associated morphological, cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database.
OBJECTIVE
To provide population-based estimates of the prevalence of lipodystrophy syndrome and constituent symptoms and to identify correlates of prevalent symptomology.


METHODS
Participants in a province-wide HIV/AIDS treatment programme reported morphological and metabolic abnormalities. Probable lipodystrophy was defined as self-report of at least one morphological abnormality or both high cholesterol and triglyceride levels. Explanatory variables investigated included: age; sex; ethnicity; transmission risk group; CD4 cell count; plasma viral load; AIDS diagnosis; duration of infection; alternative therapy use; past, current and duration of use of antiretroviral therapy (ART) by class and specific drug; total duration of ART; and current adherence. Stepwise logistic regression identified possible determinates of lipodystrophy.


RESULTS
Of 1035 participants, 50% appeared to have probable lipodystrophy, with 36% reporting peripheral wasting, 33% abdominal weight gain, 6% buffalo hump, and 10 and 12% increased triglyceride or cholesterol levels, respectively. In multivariate analysis, lipodystrophy was associated with older age (per year) (AOR 1.03; 95% CI 1.01, 1.04), the use of ingested alternative therapies (AOR 1.46; 95% CI 1.06, 2.01), having ever used protease inhibitors (PI) (AOR 2.63; 95% CI 1.89, 3.66), and duration of stavudine treatment (per year) (AOR 1.35; 95% CI 1.15, 1.58). In analysis limited to participants exposed to PI, after similar adjustment, the duration of lamivudine rather than stavudine treatment was associated with lipodystrophy (AOR 1.32; 95% CI 1.13, 1.53).


CONCLUSIONS
Increased risk of abnormalities is associated with the use of PI, and the duration of stavudine and lamivudine treatment after adjustment for personal characteristics, clinical disease stage, duration of infection and detailed treatment history.
Heath
K V
KV
Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
Hogg
R S
RS
Chan
K J
KJ
Harris
M
M
Montessori
V
V
O'Shaughnessy
M V
MV
Montanera
J S
JS
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D000328:Adult; D002170:Canada / Q000453:epidemiology; D002784:Cholesterol / Q000378:metabolism*; D000529:Complementary Therapies; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D008060:Lipodystrophy / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D013577:Syndrome; D014280:Triglycerides / Q000378:metabolism*; D019282:Wasting Syndrome
D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D014280:Triglycerides; D002784:Cholesterol