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Identification of Fat Redistribution / Metabolic Anomalies in a Cohort Treated by 2 NRTIs + 1 PI, and Absence of Significant Modification Following PI-Substitution S. GHARAKHANIAN*, Y. SALHI, N. ADDA, C. VIGOUROUX, J. CAPEAU, and W. ROZENBAUM.
Rothschild Hosp., Paris, France Aim: To identify clinical/laboratory features and risk factors of the HIV-associated lipodystrophy sydrom in a cohort treated by 2 NRTIs & 1 PI, providing a framework to allow an evaluation of the impact of antiretroviral modifications.
Methods: Cross sectional study of pts treated by PI for > 3 months by a comprehensive examination including 14 clinical & anthropometric endpoints, lipid, glucose (75gr OGTT), insulin dosage. In a subset of these pts with HIV RNA < 500cp/ml and at least one clinical and laboratory anomaly, PI was substituted for efavirenz, with NRTI unchanged, and pts were followed-up prospectively for a year.
Results: 624 pts (84% M, 16% F), aged 40+9 yrs, AIDS in 31% were studied in an HIV referral center. Frequency of clinical anomalies was high (85%), with differences between the sexes Tri-/bicipital skinfold show the most consistent change albeit subject to variability. 3 clinical subtypes were identified: atrophic pts (20%), pts with increased adiposity (22%), mixed/heterogenous types (58%). 34% had glucose intolerance/diabetes. 42% had hyperinsulinemia, Cholesterol was NCEP high/very high in 36% and triglycerides in 14% of pts. Duration of therapy is a notable risk factor. Thirty-three pts from this cohort treated by PI for a median of 24 months [5-35] mainly by indinavir (84%), associated with d4T/3TC in 81% of cases underwent substitution of PI by efavirenz. No significant difference was observed at month ten for weight, fat redistribution patterns, lipid & glucose/insulin abnormalities. 4 patients withdrew for adverse events of laboratory anomalies.
Conclusion: Fat redistribution is a chronic condition defined by clinical & laboratory anomalies. PI-substitution with efavirenz does not seem to lead to significant improvement of clinical or biological anomalies.
Key Words: HAART, Lipodystrophy, Protease inhibitor
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