Lipoatrophic men 44 months after the diagnosis of lipoatrophy are less lipoatrophic but more hypertensive.
OBJECTIVE
To identify clinical factors associated with HIV-associated lipoatrophy and to evaluate body composition changes, blood pressure and lipid levels in lipoatrophic subjects 3-4 years after the atrophy diagnosis.


METHODS
Clinical signs of lipoatrophy were assessed in 308 ambulant HIV-positive patients in 2000-2001. Possible clinical risk factors, such as age, gender, race, wasting, duration of HIV infection, presence or absence of AIDS diagnosis, viral load and CD4 count, and detailed information about drug treatment were analysed and explored in a multivariate model. Lipoatrophic white males with triceps skin fold <10 mm were re-examined after 44 months. Signs of lipoatrophy and associated factors, blood pressure, lipid levels, diet and level of exercise at first and second visits were compared.


RESULTS
In the multivariate analysis, significant clinical risk factors for lipoatrophy were weight loss >7 kg compared to normal weight [odds ratio (OR) 3.76; 95% confidence interval (CI) 1.80-7.82; P<0.001], current and/or previous use of stavudine (OR 3.72; 95% CI 1.57-8.83; P=0.003) and duration of HIV infection >80 months (OR 2.28; 95% CI 1.13-4.59; P=0.021). Forty of 47 lipoatrophic white males with skin fold < 10 mm were available for re-examination. Of these, 15 (38%) no longer fulfilled the atrophy diagnosis (P<0.001). The prevalence of arm atrophy fell from 63 to 28% (P=0.001) and facial atrophy from 55 to 43% (P=0.23). Use of stavudine for < 36 months was significantly associated with lipoatrophy reversal (OR 5.00; 95% CI 1.15-21.80; P=0.032), but weight gain and increased CD4 count were not. Prevalence of hypertension increased from 28 to 50% (P=0.035), mean systolic blood pressure from 130+/-14 to 136+/-19 mmHg (P=0.021) and diastolic blood pressure from 82+/-10 to 87+/-12 mmHg (P<0.001). In spite of increased use of lipid-lowering drugs (from two to nine patients), levels of total cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides were unchanged.


CONCLUSIONS
In this study, we found that weight loss >7 kg, use of stavudine and long duration of HIV infection were significant risk factors for clinical lipoatrophy. Clinical lipoatrophy was partly reversible, and <36 months on stavudine was significantly associated with atrophy reversal. The prevalence of hypertension and the yearly increase of mean blood pressure were disturbingly high in these patients. However, the number of patients in this study was limited, and prospective studies in larger cohorts are required to confirm these findings.
Bergersen
B M
BM
Department of Infectious Diseases, Ulleval University Hospital, Oslo, Norway. b.m.bergersen@medisin.uio.no
Sandvik
L
L
Ellingsen
I
I
Bruun
J N
JN
D000273:Adipose Tissue / Q000503:physiopathology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D001823:Body Composition / Q000502:physiology; D018791:CD4 Lymphocyte Count; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D004032:Diet; D015444:Exercise / Q000502:physiology; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D018119:Stavudine / Q000627:therapeutic use; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D015431:Weight Loss / Q000502:physiology
D019380:Anti-HIV Agents; D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D014280:Triglycerides; D002784:Cholesterol; D018119:Stavudine