Question

Dearest Dr Young,

I know that there are several factors involved but, as a general rule, what percentage of people that start HAART with one of the current 5 US-recommended combinations will develop obvious fat or other physical changes in their first 10-15 years of treatment? Happy new year to all of us!

Warm regards, John

Answer

Hello and thanks for posting.

New onset lipodystrophy is much less common than in past years (especially when we used a lot of d4T or AZT for treatment).

In large, well-controlled clinical trials of current treatments, new onset lipodystrophy is very rare. One of the best, long-term reports on lipo with integrase inhibitors comes from the analysis of raltegravir (Isentress). In
this report of people in the STARTMRK study , there were no reported cases of lipodystrophy among those who started raltegravir, and only ~1% among those who started efavirenz (Atripla).

As you note, people who had more risks, extensive disease and treatment history (in the BENCHMRK study), about 5% developed lipodystrophy.

Hope that's helpful, BY