Incidence of adipose tissue alterations in first-line antiretroviral therapy: the LipoICoNa Study.
BACKGROUND
Adipose tissue alterations (ATAs) are a frequent untoward effect of antiretroviral therapy, the causes of which remain incompletely explained.


OBJECTIVE
To assess the incidence of ATAs and to identify the associated risk factors in patients infected with human immunodeficiency virus type 1 starting their first-line antiretroviral treatment.


METHODS
In a multicenter investigation designed to study issues related to the treatment of patients starting antiretroviral therapy, physicians were requested to assess the presence of ATAs at enrollment and every 6 months thereafter. The ATAs were considered altogether and grouped as fat loss (lipoatrophy), adipose tissue accumulation (lipohypertrophy), and combined forms.


RESULTS
A total of 655 patients were followed up for a median of 86 weeks; 128 patients (19.6%) were diagnosed as having at least 1 morphologic alteration during the study. Female gender and positivity for hepatitis C virus were independently linked to an increased risk of developing morphologic alterations. Age was another independent correlate of risk of developing ATAs. To have been infected through drug injection was a correlate of reduced risk of ATAs. Stavudine exposure was predictive at borderline statistical significance of lipoatrophy (but not of the other forms), and indinavir exposure was associated with a significantly higher risk of developing combined forms. Patients who started therapy with 2 nucleoside reverse transcriptase inhibitors and subsequently added a protease inhibitor during the follow-up had a significantly higher risk of having ATAs compared with patients who continued taking 2 nucleoside reverse transcriptase inhibitors up to the end of follow-up.


CONCLUSIONS
Different types of ATAs might derive from distinct pathways and multifactorial causes. Adipose tissue alterations are a frequent and relatively early finding during first-line antiretroviral therapy.
Galli
Massimo
M
Institute of Infectious Diseases and Tropical Medicine, University of Milan, "L Sacco" Hospital, Via G. B. Grassi, 74 20157 Milan, Italy. masgalli@mailserver.unimi.it
Cozzi-Lepri
Alessandro
A
Ridolfo
Aana Lisa
AL
Gervasoni
Cristina
C
Ravasio
Laura
L
Corsico
Laura
L
Gianelli
Erika
E
Vaccarezza
Mauro
M
Vullo
Vincenzo
V
Cargnel
Antonietta
A
Minoli
Lorenzo
L
Coronado
Olga
O
Giacometti
Andrea
A
Antinori
Andrea
A
Antonucci
Giorgio
G
D'Arminio Monforte
Antonella
A
Moroni
Mauro
M
D000273:Adipose Tissue / Q000187:drug effects* / Q000503:physiopathology; D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008060:Lipodystrophy / Q000139:chemically induced* / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution
D017320:HIV Protease Inhibitors