Lipodystrophy-associated morphological, cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database

Objective: To provide population-based estimates of the prevalence of lipod ystrophy syndrome and constituent symptoms and to identify correlates of pr evalent symptomology. Methods: Participants in a province-wide HIV/AIDS treatment programme repor ted morphological and metabolic abnormalities. Probable lipodystrophy was d efined as self-report of at least one morphological abnormality or both hig h cholesterol and triglyceride levels. Explanatory variables investigated i ncluded: age; sex; ethnicity; transmission risk group; CD4 cell count; plas ma viral load; AIDS diagnosis; duration of infection; alternative therapy u se; past, current and duration of use of antiretroviral therapy (ART) by cl ass and specific drug; total duration of ART; and current adherence. Stepwi se logistic regression identified possible determinates of lipodystrophy. Results: Of 1035 participants, 50% appeared to have probable lipodystrophy, with 36% reporting peripheral wasting, 33% abdominal weight gain, 6% buffa lo hump, and 10 and 12% increased triglyceride or cholesterol levels, respe ctively. In multivariate analysis, lipodystrophy was associated with older age (per year) (AOR 1.03; 95% CI 1.01, 1.04), the use of ingested alternati ve therapies (AOR 1.46; 95% CI 1.06, 2.01), having ever used protease inhib itors (PI) (AOR 2.63; 95% CI 1.89, 3.66), and duration of stavudine treatme nt (per year) (AOR 1.35; 95% Cl 1.15, 1.58). In analysis limited to partici pants exposed to PI, after similar adjustment, the duration of lamivudine r ather than stavudine treatment was associated with lipodystrophy (AOR 1.32; 95% Cl 1.13, 1.53). Conclusion: Increased risk of abnormalities is associated with the use of P I, and the duration of stavudine and lamivudine treatment after adjustment for personal characteristics, clinical disease stage, duration of infection and detailed treatment history. (C) 2001 Lippincott Williams & Wilkins.