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The Body Covers: The First International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
Session 5: Recent Cohort Studies

June 27, 1999

Carr and colleagues examined the association between nucleoside reverse transcriptase (NRTI) therapy and the development of lipodystrophy (LD), following five patient groups: patients with LD who received NRTI-only therapy (n = 14); patients without LD who received NRTI-only therapy (n = 28); patients with LD who received protease inhibitor (PI) + NRTI therapy (n = 44); patients without LD who received PI + NRTI therapy (n = 102); and treatment-naïve patients without LD (n = 32). The authors assessed each group for age, duration of HIV, AIDS, viral load, and CD4+ cell count. Of the baseline characteristics, only age was significantly associated with LD. However, among the NRTI-only group, patients with longer duration of HIV, AIDS, and lower CD4+ count appeared to be more affected by LD.

Using multivariate analysis, they determined that d4T use and duration of NRTI use were correlated with LD among patients receiving only NRTIs. Among all patients, d4T use, the duration of NRTI or PI use, and elevated lactic acid were significantly associated with peripheral fat wasting; 3TC and PI use were associated with central obesity and buffalo hump.

While the data suggest associations between specific drugs and LD, the study only considered current drug use. Patient drug history was not available, limiting the ability to interpret the data. Patients with LD receiving NRTI-only were more likely to be more progressed and had a longer average duration of HIV infection; thus, they were more likely to have a longer duration of NRTI use. d4T is more commonly used after some period of AZT use. Since duration of NRTI use is associated with peripheral fat wasting, the data may only be reflecting the fact that patients were more likely to be on d4T with increasing duration of therapy. Therefore, the associations may only be temporal and may not show a direct relationship between particular drugs and LD. Another limiting factor of the study is the small sample size and lack of randomization, which could introduce bias into these results.

Abstract: A Syndrome of Lipodystrophy (LD), Lactic Acidemia and Liver Function Associated with HIV Nucleoside Analogue Reverse Transcriptase Inhibitor Therapy: Contribution to PI-Related Syndrome
Authored by: A. Carr, J. Miller, M. Law, and D.A. Cooper

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