7th Conference - Abstract 23

Clinical Factors Related to the Severity of Fat Redistribution in the HIV Outpatient Study (HOPS)

K. LICHTENSTEIN^*1, D. WARD², K. DELANEY³, A. MOORMAN³, F. PALELLA⁴, B. YOUNG¹, K. WOOD⁵, S. HOLMBERG³, and the HOPS Investigators. ¹Rose Med. Group/ Univ. Colorado Hlth Sci. Ctr., Denver; ²Dupont Circle Physicians Group, Washington, DC; ³CDC, Atlanta, GA; ⁴Northwestern Univ. Med. Sch, Chicago, IL; and ⁵APACHE Med. Systems, Inc., McLean, VA

Objectives and Methods: To analyze factors related to physical manifestations of fat redistribution among patients in the HOPS, 1077 (89%) of patients visiting 8 clinics in 7 U.S. cities from 10/98-12/98 were interviewed and assessed by HOPS clinicians. We characterized physical signs of fat redistribution and compared those with none or mild vs. moderate to severe signs in stratified and logistic regression analyses to evaluate associations between the fat redistribution with demographics, HIV/AIDS history, CD4+ cell (CD4) count and percent, and antiretroviral treatment history.
Results: Many time-dependent factors, most strongly age (age >40 vs. £40, OR=2.46, p=.0001) and also years since first positive HIV test (>7 vs. £7, OR=1.41, p=.05)or AIDS diagnosis (>2 vs.³2, OR=1.47, p=.05) and months since nadir CD4 (<6 vs. ³ 6, OR=2.05, p=.003) as well as use of stavudine (³ 6 vs. < 6 mos, OR=2.97, p=.0001) and use of indinavir (³ 2 vs. < 2 yrs., OR=2.11, p=.0003), were associated with moderate/severe fat redistribution. Factors related to the duration and severity of HIV disease and recovery time, such as nadir CD4 percent (nadir of <15 vs. ³ 15%, OR = 1.77, p=.0012) and body mass index ([BMI] loss ³ 1.0 vs. < 1.0, OR=1.68, p=.0012; range of BMI change ³ 2.0 vs. <2.0, OR =1.66, p=.01), had separate and strong associations with the syndrome.
Conclusions: HIV-associated lipodystrophy is both frequent and apparently multifactorial in etiology. While likelihood of lipodystrophy increased and was associated most strongly with increasing patient age, the use of one protease inhibitor (PI) or one non-PI drug and several demographic, clinical, immunologic and virologic factors associated with length of time and severity of HIV infection were also associated with clinical lipodystrophy.

Key Words: antiretrovirals, fat redistribution, lipodystrophy