Background: The prevalence and incidence of the lipodystrophy syndrome over time in HIV-infected patients are still poorly known. Our objective was to study the natural course of clinical lipodystrophy, and of glucose and lipid abnormalities after initiation of PI therapy.

Methods: The presence of lipodystrophy (physician assessment), hyperlipidaemia and glucose tolerance abnormalities (1998 WHO criteria) was assessed in the APROCO Cohort (ANRS, EP11) twice since the initiation of a PI-containing regimen through a repeated cross-sectional study: at month 12 and month 24 in patients enrolled in 1998 (group 1), and at month 20 and month 36 in patients enrolled in 1997 (group 2). The prevalence of these disorders was estimated at each studied time and the incidence of new cases (among patients free of this disorder at the first assessment) was estimated in patients for whom data where available for the 2 periods of measure.

Results:	Group 1							Group 2
	Month 12			Month 24				Month20			Month36
Prevalence (P)	N*	P (%)		N*	P (%)			N*	P (%)		N*	P (%)
Lipodystrophy	293	60		244	66			321	62		241	61
Triglyceridemia ³2.2 mmol/L	263	24		221	27			289	32		213	35
Total cholesterolemia ³5.5 mmol/L	263	59		221	58			289	55		213	47
Glucose tolerance abnormalities†	244	20		186	20			249	25		184	28
Diabetes	244	3		186	6			249	8		184	10

 

	Month 12à Month 24			Month 20à Month 36
Incidence (I)	N*	I (%PA)		N*	I (%PA)
Lipodystrophy	64	47		70	25
Triglyceridemia ³2.2 mmol/L	196	15		112	19
Total cholesterolemia ³5.5 mmol/L	53	21		70	17
Glucose tolerance abnormalities†	97	14		108	15
Diabetes	117	6		131	9

* number of patients evaluated             † including diabetes                PA: patient-years

Conclusions: In our population, lipodystrophy was present since the first year in a majority of patients but new cases appeared long after the initiation of a PI therapy. Among metabolic abnormalities, diabetes has become over time a major concern, since it was observed in 10% of the patients seen at month 36.