2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 13-15 September 2000, Toronto, Canada

PREVALENCE OF LIPODYSTROPHY SYNDROME IN A COHORT OF PATIENTS EXPOSED TO ANTIRETROVIRAL DRUG THERAPY

Antiviral Therapy 2000; 5(Suppl. 5):11 (abstract no. O16)

E Ekong¹, A Uwah² and A Akanmu^3
1Dept of Medicine, Military Hospital, Yaba, Lagos, Nigeria; ²Central Public Health Laboratory, Yaba, Lagos, Nigeria; and ³Dept of Haematology, Lagos University Teaching Hospital, Surulere, Lagos, Nigeria

BACKGROUND: Antiretroviral (ARV) drugs, especially protease inhibitors (PIs), have been known to cause lipodystrophy, hyperlipidaemia and impaired glucose tolerance resulting in various physical bodily changes.

OBJECTIVES: To study the prevalence of lipodystrophy syndrome (LS) among HIV/AIDS patients receiving treatment in four hospitals in Nigeria.

DESIGN: Cross-sectional study of HIV/AIDS patients on various ARV drugs. Information was received from patients and their physicians using a standardized questionnaire and physical examination. Demographic data, CD4 and CD8 cell counts, haemoglobin (Hb), possible source and length of HIV infection, drug history, weight, biochemical parameters (lipids, glucose, insulin levels and sensitivity and liver function tests) and circumferences of the waist, hip, chest and skin-fold thickness tests were also noted.

RESULTS: Period of study was December 1999 to May 2000. Total number of patients was 84, 75% male, median age 29±13years. CDC stages: A3, 45; A2, 18; B3, 11. Mean CD4 cell count was 520 cells/mm³. Only 59 patients had ever received PI, 14% of which were due to side-effects, and 30% were also on dual NRTIs (zidovudine, lamivudine and stavudine). Median exposure time to PIs and NRTIs was 4 and 7 months, respectively. Patients' perceived changes (PPC) was 48%, while physicians' assessment (PA) was 61%. Changes in body shape were: 35% of PI-exposed; and 15% of those on either mono- or dual-NRTIs. PPCs were central obesity (55%), wasting of buttocks (38%), lipoatrophy of the arms (30%), wasting of facial muscles (25%) and prominent veins (25%). PAs were central obesity (61%), wasting of buttocks (45%), lipoatrophy of the arms (35%), wasting of facial muscles (38%) and prominent veins (25%). In PI-exposed patients, 36% had hyperglycaemia (15% with a family history of diabetes), 30% glucose intolerance, 15% hypercholesterolaemia and 10% hypertriglycerides. In the NRTI group, insulin resistance was found in only 20%.

CONCLUSIONS: ARV drug-induced LS is common, especially in PI-treated patients. Diabetes and other metabolic complications are also common. Truncal obesity and wasting of buttock muscles are the most common forms of lipodystrophy.

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