538   Prevalence of Lipodystrophy and Metabolic Abnormalities in the Multicenter AIDS Cohort Study (MACS).

L. Kingsley*¹, E. Smit², S. Riddler¹, R. Li², J. Chmiel³, F. Palella³, B. Visscher⁴, J. Oishi⁴, E. Taylor⁴, A. Dobs⁴, and R. Evans¹.
¹Univ. of Pittsburgh, PA;²Johns Hopkins Univ., Baltimore, MD;³Northwestern Univ., Chicago, IL; and⁴Univ. of California at Los Angeles.

Background:The prevalence of lipodystrophy syndrome (LS) and high cholesterol and triglycerides varies considerably, depending on the definition and the study population. We present prevalence estimates of LS and metabolic abnormalities in the well-characterized MACS.

Methods:Through July 2000, 868 MACS participants underwent a physical exam for body changes, with blood drawn for cholesterol (TC, HDL, LDL), triglycerides (TG), hemoglobin A1c, insulin, apolipoprotein A/B, and lipoprotein A. Comparisons were made between HIV^-and HIV⁺men grouped by treatment status, including no treatment (NORX), mono/combination treatment (MCRX) and highly active antiretroviral therapy (HAART). LS was stratified by mild, moderate and severe.

Results:The prevalence of any body change was very high in HIV^-men (33%) and even higher among HIV⁺men (63%). A symptom combination of moderate or severe peripheral wasting (thinning of arms or legs) and central adiposity (increase in abdomen or breasts, or loss in buttocks) was the best working definition to minimize prevalence in the HIV^-men (<1%), MC RX men (2%) and NO RX men (<3%); this same definition showed a 20% prevalence in the HAART men (p < 0.001). The prevalence of LS rose sharply, from 0% to 20%, after two years on HAART but showed no evidence for a further rise up to four years on HAART. Elevated TC (>240 mg/dL) was more frequent among HIV⁺men on HAART (29%) than HIV^-men (19%, p = 0.01). Men on HAART also had a higher prevalence of the following parameters: low HDL (<35 mg/dL: 23% vs 1%, p < 0.001); high TG (>400 mg/dL: 23% vs 3%, p < 0.001); high glucose (>125 mg/dL: 13% vs 6%, p = 0.03) and high insulin levels( >20 mU/mL: 27% vs 16%, p = 0.02).

Conclusions:The most intriguing observation is the plateau in prevalence of LS after two years on HAART, suggesting that fewer HAART-treated persons may develop clinically appreciable LS. Our data also demonstrate the need to include appropriate HIV^-controls in studies of LS. While elevated TC and TG are clearly associated with this new syndrome, we suggest that the excess attributable to HAART may be less than current estimates.