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Factors Related to the Presence of Fat Redistribution in HIV-Infected Patients Treated With Protease Inhibitor (PI)-Containing Regimens, APROCO Cohort, 1999 M. SAVES*, F. RAFFI, J. CAPEAU, J. M. LANG, D. PEYRAMOND, A. BASDEVANT, S. ROLOFF, G. CHENE, W. ROZENBAUM, and the APROCO STUDY GROUP.
INSERM U. 330, Bordeaux; Nantes Hosp., Nantes; INSERM U. 402; Strasbourg Hosp., Strasbourg; Lyon Hosp., Lyon; Hotel-Dieu, Paris; X. Bichat Univ., Paris; Agence Natl. de Recherches sur le Sida (ANRS) and APPIT, France Objective: To study factors associated with lipodystrophy (LD) at M12 or M20 after starting a PI-containing regimen in a large, representative sample of patients.
Method: The APROCO Cohort (ANRS EP11) enrolled 1283 patients at initiation of PI over 2 periods: 5/97-10/97 (period I) and 1/98-6/98 (period II). Presence of signs of fat redistribution was assessed at M20 in patients included during period I (53% indinavir, 22% ritonavir, 18% saquinavir) and at M12 in patients included during period II (31% indinavir, 55% nelfinavir). Predictive factors of the presence of at least one sign of LD: demographics, HIV/AIDS history, prior treatment with nucleoside analogs (NRTI), baseline body mass index (BMI), CD4+ count, CD8+ count, HIV RNA, PI and NRTI prescribed, CD4+ and HIV RNA responses to HAART at Month 1 and Month 4.
Results: Among 207 patients with available data at M12, 60% had at least one sign: atrophy only in 16%, hypertrophy only in 23% and both in 20%. Hypertriglyceridemia (>2.2 mmol/l) was present in 26%, hypercholesterolemia (> 6.2 mmol/l) in 39% and diabetes in 3%. Among 202 patients with available data at M20, 60.4% had at least one sign: atrophy only in 14%, hypertrophy only in 23% and both in 23%. Hypertriglyceridemia (>2.2 mmol/l) was present in 30%, hypercholesterolemia (> 6.2 mmol/l) in 34% and diabetes in 9%. Only frequency of diabetes differed significantly between the groups seen at M12 and M20 (p=0.03). In the multivariate analysis, age > 55 years was associated with a higher prevalence of LD (OR=10.6 vs age < 35; p=0.04), and BMI < 19 was associated with a lower frequency of LD (OR=0.21 vs BMI 20-25; p=0.04). In the group assessed at M20, no factor was associated with a higher frequency of LD.
Conclusion: LD was evidenced in 60% of patients after one year of PI initiation. At M12, LD was associated with host factors. At M20, it was not possible to find predictive factors of LD. Immuno-virological characteristics at baseline and in response to HAART, type of PI used were not associated with a higher frequency of LD. Duration of exposure to the different antiretrovirals used will be further analyzed.
Key Words: lipodystrophy, prognostic factors, protease inhibitors
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