Factors related to clinical manifestations of fat redistribution were assessed in 1,077 patients in the HIV Outpatient Study (HOPS). Fat redistribution was graded as either none, mild, moderate, or severe. Severity of fat redistribution was determined to be independently associated with duration of HIV infection, age, and days on d4T, indinavir (IDV), nucleoside reverse transcriptase inhibitors (NRTIs) or protease inhibitors (PIs).

The authors note that the data should be interpreted with caution because d4T and IDV may act as markers of therapy duration. Since these drugs are relatively well tolerated and used later in the course of HIV disease, it is more likely that patients in this cohort are on these drugs at the time of the development of lipodystrophy. Therefore, no cause-effect relationship can be interpreted from the data. The authors noted, though, that fat redistribution may be multifactoral, considering the observed correlation with age, CD4% nadir (the lowest ever CD4%), duration of infection, and antiretroviral use.