947
Incidence of Lipodystrophy and Metabolic Syndrome after the Initiation of Combined ART in Sub-Saharan cART-naive Patients
Serge Eholie*1, K Lacombe2,3,4, L Denoeud4, C Adje1, F Cao4, O Bouchaud5, L Slama6, R Landmann7, E Bissagnene1, and P M Girard3,4
1Hosp de Treichville, Abidjan, Côte d`Ivoire; 2INSERM UMR S707, Paris, France; 3Univ Pierre and Marie Curie, Paris, France; 4Hosp St Antoine, Paris, France; 5Hosp Avicenne, Bobigny, France; 6Hosp Tenon, Paris, France; and 7Hosp Bichat, Paris, France
Background:
As the access to combined ART (cART) is rapidly
expanding in Sub-Saharan Africa, to optimize the therapeutic strategy, a
great concern is assessing the risk of lipodystrophy and metabolic syndrome.
Methods: HIV-1-infected cART-naive patients living in Abidjan, Côte d'Ivoire, were enrolled in a 4-year cohort study. Clinical and biological characteristics were
collected every 3 and 6 months and used to calculate the cumulative incidence
(CI) and incidence rate of lipodystrophy and metabolic syndrome following cART initiation. Lipodystrophy was
defined by the presence of 1 or more signs of peripheral lipoatrophy and
central lipohypertrophy. Metabolic syndrome was defined by the association of
at least 3 of the following criteria: triglyceridemia >1.7 mM/L; HDL
cholesterol <1 mM/L in men or 1.3 mM/L in women; glycemia ≥6.1 mM/L; waist
circumference >102 cm in men or 88 cm in women; systolic blood pressure ≥135 mmHg or diastolic blood pressure ≥85 mmHg.
Results:
At inclusion, 171 patients (mean age, 35.7 years,
SD 7.4; sex ratio, 0.63; mean body mass index, 20.6, SD 2.5) had a median time from
HIV diagnosis of 2.7 months (IQR 1.7 to 7.1), with a mean CD4 cell count of
123/μL (SD 87.6) and a mean HIV RNA of 5.3 log10 copies/mL (SD 0.8).
An AIDS-defining event was noted in 21%. Most patients received zidovudine (AZT)
+ lamivudine (3TC) + efavirenz (EFV) (57%) or stavudine (d4T) + 3TC +
nevirapine (NVP) (21%) as initial cART regimen. The incidence rate of lipodystrophy
was 1.94/100 person-months (95%CI 1.46 to 2.57), with a CI of 28%
(n = 48), after a 15-month, median duration of cART exposure (IQR 11 to 17).
Lipohypertrophy, lipoatrophy, and mixed lipodystrophy
were noted in 23% (n=39), 4% (n=7) and 1% (n=2) of the patients, respectively.
The incidence rate of metabolic syndrome was 0.48/100 person-month (95%CI 0.28
to 0.85), with a CI of 7% (n = 12) after a 16-month, median duration of
cART exposure (IQR 11 to 23). The CI of metabolic events were as follows: hypertriglyceridemia,
16% (n = 24), hyperglycemia, 2% (n = 3), waist circumference
increase, 14% (n = 24), and blood pressure increase, 38% (n = 59).
Conclusions:
Incidence of lipodystrophy and metabolic syndrome after
cART initiation in West African patients is similar to that previously observed
in Caucasian patients. A closer clinical and biological evaluation, as well as
access to drugs with fewer metabolic effects, should be essential components of
the cART strategy implementation in West Africa.
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