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The Body Covers: The First International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

Session 5: Recent Cohort Studies

Coverage provided by Abhimanyu Garg, M.D.

June 27, 1999

Data on 1077 patients from 8 clinics in 7 US cities were presented. These data were collected between 10/98 to 12/98 by using a questionnaire that was completed by the treating physician in the presence of the patient. The data on lipodystrophy were then classified on the basis of the severity of physical findings and number of areas affected. Of all respondents, 51% had no physical manifestations (level A), 30% had 1-2 mild/moderate signs including central adiposity, fat loss in extremities or hips (level B, mild); 13% had 3-4 mild/moderate signs including facial changes (level C, moderate) and 6% had 5-6 signs, some severe, including dorsocervical fat pad (level D, severe).

The following table provides frequency of impaired glucose tolerance (IGT) and median values for plasma triglycerides (TG) and cholesterol (CH) concentrations in these categories:

  Severity Level
A B C D
IGT (%) 5 6 9 17
Plasma CH (mg/dL) 192 203 206 212
Plasma TG (mg/dL) 187 236 260 321

Severity of lipodystrophy was associated with following factors after adjusting for the duration since HIV diagnosis: age, lowest ever CD4 count and duration of therapy for stavudine, lamivudine, indinavir and saquinavir.

This cross-sectional study suggests that causes of lipodystrophy syndrome may not be limited to protease inhibitor therapy. Other factors such as time since HIV diagnosis, immune factors, age and other antiretroviral agents may play a role in causing fat redistribution. The limitation of the study was that the classification of severity was based on subjective criteria only.




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