title: Lipodystrophy and metabolic disorders in HIV-1-infected adults on 4- to 9-year antiretroviral therapy in Senegal: a case-control study.
abstract: OBJECTIVE
  To assess adverse effects of long-term highly active antiretroviral therapy (HAART), that is, lipodystrophy and metabolic disorders, in a cohort of African patients.
  
  
  METHODS
  One hundred eighty HIV-1-infected patients treated with HAART for 4-9 years in Dakar and 180 age-matched and sex-matched controls were enrolled. Regional subcutaneous fat changes were assessed by physicians, and fasting blood samples were drawn. Centralization of body fat was estimated using skinfold ratio, waist circumference, and waist to hip ratio (WHR).
  
  
  RESULTS
  Mean duration of HAART was 5.4 years. Main drugs received were zidovudine, stavudine, and protease inhibitors. The prevalence of moderate-severe lipodystrophy was 31.1% (95% confidence interval: 24.3 to 37.9), with 13.3%, 14.5%, and 3.3% for lipoatrophy, lipohypertrophy, and mixed forms, respectively. Mild-severe lipodystrophy affected 65.0% (58.0; 72.0) of patients. Stavudine was the only independent risk factor (any vs. none: odds ratio = 2.8; 1.4 to 5.5). Patients had lower body mass index and skinfolds but greater centralization of body fat (WHR, P < 0.0001 and skinfold ratio, P < 0.001), fasting glucose (P < 0.0001), homeostasis model assessment insulin resistance, and triglyceride levels (P < 0.01 for both) than controls. Moderately-severely lipodystrophic patients had higher triglyceride and low-density lipoprotein cholesterol than other patients (P < 0.001 and P < 0.05, respectively).
  
  
  CONCLUSIONS
  Moderate-severe lipodystrophy affected one third of West African patients on long-term HAART and was associated with a less favorable metabolic profile.
authors.affiliation: IRD, UR024, Montpellier, France.
authors.forename: Sabine
authors.initials: S
authors.lastname: Mercier
authors.forename: Ndeye Fatou Ngom
authors.initials: NF
authors.lastname: Gueye
authors.forename: Amandine
authors.initials: A
authors.lastname: Cournil
authors.forename: Annick
authors.initials: A
authors.lastname: Fontbonne
authors.forename: Nane
authors.initials: N
authors.lastname: Copin
authors.forename: Ibrahima
authors.initials: I
authors.lastname: Ndiaye
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Cécile
authors.initials: C
authors.lastname: Cames
authors.forename: Papa Salif
authors.initials: PS
authors.lastname: Sow
authors.forename: Ibra
authors.initials: I
authors.lastname: Ndoye
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.forename: Kirsten Bork
authors.initials: KB
authors.lastname: Simondon