title: Incidence of lipodystrophy and metabolic disorders in patients starting non-nucleoside reverse transcriptase inhibitors in Benin.
abstract: BACKGROUND
  The incidence and risk factors for lipodystrophy and metabolic disorders among patients in Africa on first-line combined antiretroviral treatment (cART) mostly containing non-nucleoside reverse transcriptase inhibitors is poorly documented.
  
  
  METHODS
  This prospective cohort study recruited 88 HIV-infected patients initiating cART between October 2004 and June 2005 in Cotonou, Benin. Patients were followed for 24 months. The main outcomes were incidence of lipodystrophy and metabolic disorders. Multivariate Cox proportional hazards regression models were used to describe factors associated with progression to lipodystrophy.
  
  
  RESULTS
  After a median follow-up of 23.2 months (interquartile range 22.3-23.7), 24 (30%) patients developed lipodystrophy (lipoatrophy 9%, lipohypertrophy 24% and mixed pattern 2.5%). The incidence rate for lipodystrophy was estimated to 1.72 per person-month (95% confidence interval [CI] 1.15-2.56) occurring after a median time of 11 months on cART. Metabolic syndrome (International Diabetes Federation definition) appeared in 10 (13%) patients after a median of 15 months with an estimated incidence rate of 0.62 per person-month (95% CI 0.33-1.16). It was more common in women (19.2% versus 3.1% in men; P=0.043). Diabetes (8%) and hypercholesterolaemia (35%) were also observed. After adjustment, gender, young age (hazard ratio [HR] 0.45 [95% CI 0.22-0.90]; P=0.025), high BMI at inclusion (HR 1.53 [95% CI 1.28-1.83]; P<0.0001) and smoking (HR 28.0 [95% CI 2.5-307.4]; P=0.006) were significantly associated with lipohypertrophy.
  
  
  CONCLUSIONS
  Lipodystrophy and metabolic syndrome were commonly and rapidly observed in this cohort of sub-Saharan patients initiating cART.
authors.affiliation: Service de Médecine Interne, Centre National Hospitalier et Universitaire Hubert Koutoukou Maga, Cotonou, Benin.
authors.forename: Djimon Marcel
authors.initials: DM
authors.lastname: Zannou
authors.forename: Lise
authors.initials: L
authors.lastname: Denoeud
authors.forename: Karine
authors.initials: K
authors.lastname: Lacombe
authors.forename: Daniel
authors.initials: D
authors.lastname: Amoussou-Guenou
authors.forename: Jules
authors.initials: J
authors.lastname: Bashi
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Akakpo
authors.forename: Alice
authors.initials: A
authors.lastname: Gougounon
authors.forename: Alain
authors.initials: A
authors.lastname: Akondé
authors.forename: Gabriel
authors.initials: G
authors.lastname: Adé
authors.forename: Fabien
authors.initials: F
authors.lastname: Houngbé
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D001541:Benin / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D008060:Lipodystrophy / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D024821:Metabolic Syndrome / Q000139:chemically induced / Q000453:epidemiology*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D012307:Risk Factors
chemical_list: D018894:Reverse Transcriptase Inhibitors