Incidence of morphological and lipid abnormalities: gender and treatment differentials after initiation of first antiretroviral therapy.
OBJECTIVE
To provide population-based incidence estimates for constituent symptoms of human immundeficiency virus (HIV)-related lipodystrophy syndrome and to identify possible independent predictors of accrued cases.


METHODS
Prospective population-based cohort. Methods Study subjects were antiretroviral-naïve individuals who initiated treatment between October 1998 and May 2001 and provided completed self-reported data regarding the occurrence of lipoatrophy, lipohypertrophy and increased triglyceride and cholesterol levels. Possible predictors of incident lipoatrophy, lipohypertrophy, dyslipidaemia and mixed lipodystrophy (symptoms of both lipoatrophy and lipohypertrophy) were identified using logistic regression modelling. A sub-analysis restricted to subjects retaining original treatment at study completion was conducted using similar methods.


RESULTS
Among the 366 study subjects, cumulative incidence was 29% for lipoatrophy, 23% for lipohypertrophy, 9% for dyslipidaemia, and 13% for mixed lipodystrophy after a median duration of 12 months of antiretroviral therapy. In an intentto-treat analysis incident lipoatrophy and lipohypertrophy were independently associated with initiation of protease inhibitor (PI)-containing regimens, (adjusted odds ratio [AOR] = 1.94; 95% CI: 1.25-3.03 and AOR = 1.76; 95% CI: 1.09-2.85, respectively) and female gender (AOR = 2.06; 95% CI: 1.03-4.12 and AOR = 2.36; 95% CI: 1.17-4.74, respectively). Both mixed lipodystrophy and reported dyslipidaemia were associated only with PI inclusion in the initial regimen (AOR = 2.27; 95% CI: 1.14-4.53 and AOR = 2.14; 95% CI: 1.26-3.65, respectively). Similar results were obtained in analysis of individuals retained in initial treatment groups throughout follow-up.


CONCLUSIONS
Incident morphological and lipid abnormalities are common among individuals initiating first-time antiretroviral therapy. Use of PI was consistently associated with all lipodystrophy-related abnormalities after adjustment for a broad range of patient personal, clinical and treatment characteristics.
Heath
Katherine V
KV
Centre for Excellence in HIV/AIDS, Vancouver, Canada. kheath@hiunet.ubc.ca
Chan
Keith J
KJ
Singer
Joel
J
O'Shaughnessy
Michael V
MV
Montaner
Julio S G
JS
Hogg
Robert S
RS
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000188:drug therapy; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D002784:Cholesterol / Q000097:blood; D005260:Female; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D039682:HIV-Associated Lipodystrophy Syndrome / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012723:Sex; D014280:Triglycerides / Q000097:blood
D017320:HIV Protease Inhibitors; D014280:Triglycerides; D002784:Cholesterol