title: Lipodystrophy and dyslipidemia among patients taking first-line, World Health Organization-recommended highly active antiretroviral therapy regimens in Western India.
abstract: OBJECTIVE
  To determine the prevalence of lipodystrophy, dyslipidemia, and hyperglycemia among HIV-infected patients taking long-term, first-line, World Health Organization (WHO)-recommended generic highly active antiretroviral therapy (HAART) regimens in India.
  
  
  METHODS
  : Cross-sectional study.
  
  
  METHODS
  Asymptomatic, antiretroviral-naive patients and those treated for > 1 year with zidovudine (ZDV)/lamivudine (3TC)/nevirapine (NVP) and stavudine (d4T)/3TC/NVP were subjectively assessed for lipodystrophy (lipoatrophy, lipohypertrophy, and mixed patterns), and lipid profiles were determined after an overnight fast. The US National Cholesterol Education Program III guidelines were used to define dyslipidemia (total cholesterol > or = 200 mg/dL, low-density lipoprotein cholesterol > or = 130 mg/dL, triglycerides > or = 150 mg/dL, high-density lipoprotein cholesterol < 40 mg/dL, and total cholesterol/high-density lipoprotein cholesterol ratio > or = 6.5). Prevalence and risk factors associated with these complications were determined.
  
  
  RESULTS
  Of the 306 patients (126 controls, 30 on ZDV/3TC/NVP, and 150 on d4T/3TC/NVP), the prevalence of lipodystrophy was 46.1%, and lipoatrophy was significantly associated with d4T use. The prevalence of dyslipidemia and fasting hyperglycemia was significantly higher in the treatment groups. Proportion of patients with high-density lipoprotein > or = 60 mg/dL was significantly higher in the treatment groups; however, this had little impact on the total cholesterol/high-density lipoprotein ratio.
  
  
  CONCLUSIONS
  There is a high prevalence of lipodystrophy, dyslipidemia, and hyperglycemia in patients taking long-term WHO-recommended generic HAART in western India. Interventions to address these complications need to be incorporated into antiretroviral scale-up programs, including improving access to alternative less-offending drugs like tenofovir and abacavir.
authors.affiliation: Department of HIV Medicine, Ruby Hall Clinic, Pune, Maharashtra, India. san1@medscape.com
authors.forename: Sanjay N
authors.initials: SN
authors.lastname: Pujari
authors.forename: Ameet
authors.initials: A
authors.lastname: Dravid
authors.forename: Eknath
authors.initials: E
authors.lastname: Naik
authors.forename: Shobha
authors.initials: S
authors.lastname: Bhagat
authors.forename: Kaley
authors.initials: K
authors.lastname: Tash
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Nadler
authors.forename: John T
authors.initials: JT
authors.lastname: Sinnott
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced / Q000453:epidemiology*; D007194:India / Q000453:epidemiology; D008060:Lipodystrophy / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D014944:World Health Organization