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"Lipodystrophy" is not what it used to be: data from the Swiss HIV cohort study
Presented by Alain Nguyen, Switzerland.
Nguyen A.1, Bernasconi E.2, Battegay M.3, Opravil M.4, Evison J.-M.5, Tarr P.E.6, Schmid P.7, Perneger T.8, Hirschel B.9, Swiss Hiv Cohort Study
1University Hospital Geneva, Infectious Disease Service / HIV unit, Geneva, Switzerland, 2Hospital Lugano, Infectious Disease Service, Lugano, Switzerland, 3University Hospital Basel, Division of Infectious Diseases, Basel, Switzerland, 4University Hospital Zurich, Division of Infectious Diseases, Zurich, Switzerland, 5University Hospital Bern, Infectious Disease Service, Bern, Switzerland, 6University Hospital Lausanne, Infectious Disease Service, Lausanne, Switzerland, 7Hospital St-Gall, Infectious disease unit, St-Gall, Switzerland, 8University Hospital Geneva, Quality of Care Service, Geneva, Switzerland, 9University Hospital Geneva, Infectious disease / HIV unit, Geneva, Switzerland
Background and objectives: Antiretroviral treatments are changing, and these changes may impact on lipodystrophy. For instance, lesser use of stavudine is expected to decrease lipo-atrophy, while lipo-hypertrophy, thought to be associated with protease inhibitors, might cause gain of weight. We tracked the frequency of physician-diagnosed lipodystrophy and weight changes, between 2003 and 2006, in relation to the use of specific drugs.
Methods: The Swiss HIV Cohort includes more than 14000 patients of which approximately 4000 were treated with HAART and followed 6 monthly in any given year, Treatments, and reasons for change thereof, are recorded, and at each visit, patients are scored for "fat accumulation", "fat loss"(or neither). We selected patients with BMI >20 for men and >18 for women, identified those who gained ³5 kg over 6 months ("cases"), and compared them to those who had not gained ³5 kg("controls").
Results: From 2003 to 2006, the percentage of patients taking stavudine decreased from 14.2% to 3.6%, indinavir from 3.4% to 0.7%, and nelfinavir from 15.8% to 5.5%, remained stable for lopinavir (22%), and increased for atazanvir from 2.9% to 21.5%.
The annual prevalence of weight gain ³5 kg remained stable(~7%), but the relative frequency of treatment change related to lipodystrophy decreased(see fig.1). In each year from 2003 to 2006, cases(weight gain ³5 kg)were more likely to take lopinavir or atazanavir than controls (see fig.2, p < 000.1).In multivariate logistic regression analysis, atazanavir and lopinavir were associated with weight gain of ³5 kg(OR 1.4, 95% CI 1.2-1.6 for both). With the same analysis atazanavir, indinavir, nelfinavir, efavirenz, nevirapine, abacavir predicted "fat accumulation" while stavudine, ritonavir, abacavir, efavirenz predicted "fat loss"(all results p < 0.01).
[figure 1: change because lipodystrophy]
[figure 2:cases treated with ATV and LPV]
Conclusions: Treatment changes because of lipodystrophy became rarer between 2003 and 2006. Weight gain of more than 5 kg was associated with use of atazanavir and lopinavir.
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