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Session 100
Poster Abstracts Dyslipidemias and Body Fat Abnormalities: Incidence, Risk Factors, Response to Therapy Monday, 1:30 - 3:30 pm Poster Hall |
Background: Lipodystrophy and metabolic abnormalities are common in patients taking anti-retroviral therapy. In this cross-sectional study, we investigated the prevalence of and risk factors associated with these amongst Indian patients taking long term HAART.
Methods: Asymptomatic HIV-infected patients not on ART and those for longer than 1 year on d4T/3TC/NVP were recruited consecutively over a period of 3 months. Lipoatrophy (facial, limb fat loss) and fat gain (increased abdominal, breast fat) were assessed by patient’s self-report and confirmed by clinical examination. Lipid (cholesteral‑TC, LDL, HDL‑triglycerides [TG], VLDL, and chol-HDL ratio) and glucose levels were determined after a 12-hour fast. CD4 counts done closest to the time of estimation of lipid profile were considered for analysis. We used NCEP ATP III classification for defining high lipid levels (TC ≥240, LDL ≥160, TG ≥200, and HDL ≤40). Baseline demographics were assessed by Fischer’s exact test (binary) or the Mann Whitney test (continuous). The prevalence of lipid abnormalities was determined in both groups and significance assessed by Fischer’s exact test. Logistic regression analysis was performed to assess the effects on development of dyslipidemia of treatment status, age, gender, smoking, alcohol, family history, body mass index, and CD4 counts.
Results: We studied 144 patients (88 on HAART, 56 controls). Median duration of treatment was 19 months (12 to 41). Lipodystrophy was documented in 45.5% of patients (lipoatrophy 15.9%, fat gain 14.7%, and both 14.7%). Except CD4 counts, the 2 groups were similar at baseline. Prevalence of dyslipidemia has been displayed below:
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TC≥240 |
LDL≥160 |
TG≥200 |
HDL≤40 |
F Glu ≥110 |
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Treatment (%) |
11.4 |
14.9 |
30.7 |
27.2 |
5.4 |
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Controls (%) |
0 |
0 |
3.6 |
71.4 |
0 |
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P value |
0.007 |
0.002 |
<0.0001 |
<0.0001 |
0.13 |
Apart from smoking and age, logistic regression revealed strong positive association between treatment and dyslipidemia (TC and LDL predicted perfectly, TG-adjusted OR = 12.93 (2.67 to 62.48)) and negative association with HDL (adjusted OR = 0.114 (0.04 to 0.27)).
Conclusion: There is high prevalence of morphologic abnormalities and dyslipidemia among Indians taking long-term d4T/3TC/NVP. Higher HDL levels in the treatment group may be associated with use of NVP. Programs for ART should incorporate management strategies for these adverse events.
Keywords: dyslipidemia; HAART; Developing
