403   Early Occurrence of Lipodystrophy in HIV-I-Infected Patients Treated during Primary Infection.

C. Goujard*, F. Boufassa, C. Deveau, D. Laskri, and L. Meyer for the Primo Group.
Le Kremlin-Bicetre, France.

Background:The objective of this study was to describe the incidence of clinical lipodystrophy (LD) in a prospective cohort of 186 pts diagnosed during primary HIV-I infection (PI).

Methods:A physical examination was regularly performed to assess abnormalities compatible with LD (face, limbs, trunk, abdomen, breast). Signs were rated using a scale of severity. Risk factors associated with lipodystrophy were analysed.

Results:This study included 121 pts who were prescribed HAART during PI and were treated for more than 6 months. Twenty-two pts (18.2%) presented with at least one LD abnormality after a mean follow-up of 24.0 months. The cumulative incidence of LD was 6% at 12 m, 18% at 24 m and 30% at 36 months. Despite a similar follow-up, we found significantly higher median CD4⁺and CD8⁺cell counts at the last visit in LD⁺pts (respectively 1006 and 868) than in LD^-pts (736 and 699) and a lower mean HIV RNA in LD⁺pts (l.0 log₁₀) than in LD^-pts (1.7 log₁₀; p < 0.001). The epidemiological and immunovirological data at baseline did not differ between the 2 groups, except a higher median CD8 cell count at baseline in LD⁺pts than in LD^-pts (1326 vs. 922; p < 0.001). All the LD⁺pts, except two, had received a protease inhibitor in the initial HAART.

Conclusion:Lipodystrophy can occur early after HAART initiation during primary infection. This finding argues against the sole role of the duration of HIV-1 infection in the pathogenesis of lipodystrophy.