Stavudine versus zidovudine and the development of lipodystrophy

The pathogenesis of some components of the lipodystrophy (LD) syn drome mig ht be linked to the use of nucleosides. Earlier reports did not compare tre atment regimens according to the nucleoside backbone. We studied a cohort o f individuals who did not switch between stavudine and zidovudine. LD was d efined to be present if one of three criteria was met: self-report by the p atient, observation by an investigator who had known the patient since comm encement of highly active antiretroviral therapy (HAART), or examination by a physician masked to therapy. The mean duration of therapy was 101 weeks (range: 26-234 weeks). Overall prevalence of LD was 48.7%. Lipoatrophy and lipohypertrophy occurred in 33.9% and 28.7% of patients, respectively. Logi stic regression showed four parameters to be significantly associated with lipoatrophy: HAART longer than 2 years (p = .002, odds ratio [ORI = 4.4, 95 % confidence interval [CI]: 1.608-11.965), baseline viral load > 100,000 co pies/ml (p = .004, OR = 4.3, CI: 1.726-11.197), age > 40 years (p = .016, O R = 3.2, CI: 1.247-8.373), and white ethnicity (p = .041, OR = 5.4, CI: 1.0 70-28.184). Cholesterol levels of > 200 mg/dl at baseline were associated w ith a risk reduction (p = .047, OR = 0.36, CI: 0.130-0.987). Use of lipohyp ertrophy as a dependent variable resulted in a significant association with HAART duration (p = 0.028, OR = 2.7, CI: 1.2-6.5) and protease inhibitor u se (p = .014, OR = 3.8, CI: 1.3-11.2). LD prevalence is similar with both b ackbones using stavudine or zidovudine. This is the first time that baselin e cholesterol uas shown to be significantly associated with lipoatrophy.