How common is lipodystrophy in people who have never taken HIV protease inhibitors?

Keith Alcorn
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This article is more than 22 years old.

Lipodystrophy in people who start treatment with a protease-sparing regimen may be more frequent than randomised studies have suggested, according to the results of a Spanish prospective cohort reported this week at the Sixth International Congress on Drug Therapy in HIV Infection in Glasgow.

Eleven per cent of 166 individuals who started treatment with either a triple nucleoside analogue or non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen developed body fat changes during a mean follow-up period of 14.5 months. The incidence of lipodystrophy, determined by clinician and patient report, was 7.49 cases per 100 patient years of follow-up.

In contrast the DMP-006 study found an incidence of 0.5% - 2.5% in both PI-sparing and nucleoside analogue-sparing arms of the study, a large trial that compared AZT/3TC/efavirenz, AZT/3TC/indinavir and indinavir/efavirenz over 48 weeks.

Glossary

lipodystrophy

A disruption to the way the body produces, uses and distributes fat. Different forms of lipodystrophy include lipoatrophy (loss of subcutaneous fat from an area) and lipohypertrophy (accumulation of fat in an area), which may occur in the same person.

nucleoside

A precursor to a building block of DNA or RNA. Nucleosides must be chemically changed into nucleotides before they can be used to make DNA or RNA. 

multivariate analysis

An extension of multivariable analysis that is used to model two or more outcomes at the same time.

reverse transcriptase

A retroviral enzyme which converts genetic material from RNA into DNA, an essential step in the lifecycle of HIV. Several classes of anti-HIV drugs interfere with this stage of HIV’s life cycle: nucleoside reverse transcriptase inhibitors and nucleotide reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). 

protease inhibitor (PI)

Family of antiretrovirals which target the protease enzyme. Includes amprenavir, indinavir, lopinavir, ritonavir, saquinavir, nelfinavir, and atazanavir.

The Spanish group reported that the main risk factors for lipodystrophy by multivariate analysis were age over 45 years (RH13.36) and baseline fasting triglycerides > 200mg/dL (RH 14.88).

References

Martinez E et al. A prospective cohort study on the risk of lipodystrophy in HIV-1 infected patients who have never received protease inhibitors. Sixth International Congress on Drug Therapy in HIV Infection, Glasgow, abstract P145, 2002.

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