Clinical assessment of HIV-associated lipodystrophy in an ambulatory population

Objective: To identify clinical factors associated with prevalence of fat a trophy (lipoatrophy) and fat accumulation (lipoaccumulalion) in HIV-1 infec ted patients. Design: Evaluation of HIV-1 infected patients seen for routine care between 1 October and 31 December 1998 in the eight HIV Outpatient Study (HOPS) cl inics. Setting: Eight clinics specializing in the care of HIV-1 infected patients. Patients: A total of 1077 patients were evaluated for signs of fat maldistr ibution. Interventions: A standardized set of questions and specific clinical signs were assessed. Demographic, clinical and pharmacological data for each pati ent were also included in the analysis. Main outcome measures: Demographic, immunologic, virologic, clinical, labor atory, and drug treatment factors were assessed in stratified and multivari ate analyses for their relationship to the presence and severity of fat acc umulation and atrophy. Results: independent factors for moderate/severe lipoatrophy for 171 patien ts were increasing age, any use of stavudine, use of indinavir for longer t han 2 years, body mass index (BMI) loss, and measures of duration and sever ity of HIV disease. Independent risk factors for moderate/severe fat accumu lation for 104 patients were increasing age, BMI gain, measures of amount a nd duration of immune recovery, and duration of antiretroviral therapy (ART ). The number of non-drug risk factors substantially increased the likeliho od of lipoatrophy. If non-drug risk factors were absent, lipoatrophy was un usual regardless of the du ration of drug use. Conclusions: HIV-associated lipodystrophy is associated with several host, disease, and drug factors. While prevalence of lipoatrophy increased with t he use of stavudine and indinavir, and lipoaccumulation was associated with duration of ART, other non-drug factors were strongly associated with both fat atrophy and accumulation. (C) 2001 Lippincott Williams & Wilkins.