Reduced dose of stavudine and lipoatrophy in HIV-infected patients in Cameroon.
BACKGROUND
This study assessed the effect of stavudine (d4T) 30 mg dosage on lipoatrophy in HIV-infected patients on antiretroviral treatment.


METHODS
A total of 243 patients from Cameroon receiving d4T or zidovudine (AZT) in combination with lamivudine and efavirenz or nevirapine for >6 months were clinically assessed for moderate to severe ('strict' definition) and mild to severe ('large' definition) lipoatrophy. Prevalence of lipoatrophy was compared between 69 patients who had received exclusively d4T 30 mg (d4T(30)), 64 patients who had received both d4T 30 and 40 mg dosages since treatment initiation (d4T(30/40)) and 110 patients on AZT-related therapy.


RESULTS
Prevalence of lipoatrophy varied from 7% to 24%, according to the definition. After adjustment for gender, age, treatment duration and CD4(+) T-cell count, the risk of lipoatrophy in the d4T(30) group was lower than in the d4T(30/40) group (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.8 with the large definition and OR 0.2, 95% CI 0.0-0.8 with the strict definition) and was comparable to that of the AZT group (OR 1.0, 95% CI 0.2-4.6 and OR 1.0, 95% CI 0.4-2.2 with the large and strict definitions, respectively). The risk was significantly higher in the d4T(30/40) group compared with the AZT group (OR 2.9, 95% CI 1.3-6.4 with the large definition and OR 5.5, 95% CI 1.3-23.5 with the strict definition).


CONCLUSIONS
The use of d4T at a lower dosage might increase safety with regard to its effect on lipoatrophy.
Institut de Recherche pour le Développement, University Montpellier 1, Montpellier, France. amandine.cournil@ird.fr
Amandine
A
Cournil
Mathilde
M
Coudray
Charles
C
Kouanfack
Claudine Ntsama
CN
Essomba
Clément Auguste Djouatsa
CA
Tonfack
Magloire
M
Biwolé-Sida
Eric
E
Delaporte
Kirsten
K
Bork
Christian
C
Laurent
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D002163:Cameroon; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000187:drug effects*; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000009:adverse effects; D008060:Lipodystrophy / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000008:administration & dosage / Q000009:adverse effects; D018119:Stavudine / Q000008:administration & dosage* / Q000009:adverse effects; D015215:Zidovudine / Q000008:administration & dosage / Q000009:adverse effects
D019380:Anti-HIV Agents; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; D018119:Stavudine