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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: Prospective and objective data are scarce on the evolution of limb fat and the risk for limb fat loss in antiretroviral-naive HIV-infected adults.
Methods: Consecutive asymptomatic stable antiretroviral-naive HIV-infected patients were included. Body composition (DEXA) and fasting laboratory (glucose, triglycerides, total-HDL-LDL cholesterol, insulin, lactate, TNF-a, CD4 cells, and plasma HIV-1 RNA) measurements were performed at baseline and every 6 months thereafter. Decisions regarding initiation of antiretroviral therapy and type of antiretrovirals included were independent from the participation in this study. Changes in limb fat at 6 and 12 months were assessed, and risk factors associated with limb fat loss (lipoatrophy) were investigated.
Results: From December 2001 until September 2003, 170 patients have been included: 110 (65%) started antiretroviral therapy and 59 (35%) did not according to clinical judgement. In those receiving antiretroviral therapy, drugs used were AZT (25%), d4T (15%), TDF (56%), 3TC (59%), ddI (35%), ABC (35%), EFV (40%), NVP (14%), LPVr (29%), and NFV (4%); prescribed regimen has remained unchanged in 104 (95%) of the patients. Compared with baseline, limb fat decreased in 33% (month 6) and 40% (month 12) of the patients although there was a high variability. Mean (range) changes of limb fat at month 6 and 12 were +1096 (-7372, +11,906) and -110 (-9991, +3711) g, respectively. Patients on antiretroviral therapy had lower limb fat increase at month 6 (mean 657 vs 2106 g, p <0.05) and higher limb fat decrease at month 12 (mean -199 vs 557 g, p <0.05) than those without. Patients experiencing loss of fat had significantly higher limb (mean 7735 vs 4311 g, p = 0.0001) and truncal (mean 8520 vs 5805 g, p = 0.008) fat at baseline than those not. No relationship between limb fat loss and other body composition parameters, laboratory measurements, or specific antiretrovirals could be detected.
Conclusions: In this cohort of antiretroviral-naive HIV-infected patients, there was a trend toward limb fat loss at 12 months after a moderate increase at 6 months. These changes were more pronounced in patients starting antiretroviral therapy. Baseline body fat was the only predictor for limb fat loss identified.
Keywords: lipoatrophy; body composition; risk
