Factors Associated With Lipoatrophy During HAART

In This Article

Abstract and Introduction

Abstract

Background: We aimed to study the factors associated with clinical forms of lipoatrophy in patients receiving highly active antiretroviral therapy (HAART) in Yalgado Ouédraogo Teaching Hospital, Ouagadougou, Burkina Faso.

Methods: This cross-sectional review from March 10 to November 10, 2011, included a nonprobability sample of HIV-infected adults receiving antiretroviral (ARV) medications for at least 6 months and monitored in the internal medicine department. The diagnosis of lipoatrophy was clinical.

Results: Three hundred patients were included. The sex ratio was 0.4 and the mean age was 42.1 ± 8.5 years. The mean duration of HAART was 73.2 ± 30.9 months. In all, 97 (32.3%) patients had lipoatrophy: 75 (25%) isolated and 22 (7.3%) mixed syndrome. Facial lipoatrophy was frequent (61.8%). Isolated lipoatrophy was associated with male sex (P = .002) and body mass index ≤25 (P < .05). Mixed syndrome was associated with female sex (P = .002), age >42 years (P < .05), physical activity (P = .003), smoking (P = .001), stavudine (d4T; P = .0001), or protease inhibitors (P = .01).

Conclusion: Prevention of lipoatrophy associated with HAART requires the exclusion of modifiable risk factors that we identified.

Introduction

Lipodystrophy is a disorder in fat distribution, which may occur with highly active antiretroviral therapy (HAART) during the management of HIV/AIDS.^[1,2] It consists of 2 entities that can appear together: lipoatrophy and lipohypertrophy.^[3] These phenotypes arise from different mechanisms so that their study in a single entity seems inappropriate.^[4] Lipoatrophy is certainly the most stigmatizing side effect of antiretroviral (ARV) medications and is associated with impaired quality of life, treatment noncompliance, and other deleterious metabolic comorbidities.^[1–3,5,6] Because of the characteristics of HAART regimens commonly used in developing countries, including Burkina Faso, this study was undertaken to determine the prevalence of different forms of lipoatrophy as well as the associated factors in a cohort of HIV-infected patients receiving ARV medications in Ouagadougou. The study will help to consider preventive measures against these disorders in light of the associated factors.

Table 1. Anthropometric and Demographic Characteristics in Different Groups of Patients. ^a
Characteristics	Patients with Lipoatrophy	Patients with Mixed Syndrome	Patients without Lipoatrophy
Sex ratio	0.8	0.05	0.39
Mean age, y	45.3 ± 9.3	43.5 ± 6.7	45.1 ± 7.8
Mean BMI, kg/m²	21.9 ± 3.6	22.4 ± 4.3	22.2 ± 5.5

Abbreviation: BMI, body mass index.
^aN = 300.

Table 2. Demographic and Anthropometric Factors Associated with Different Types of Lipoatrophy. ^a
Associated Factors	Isolated Lipoatrophy n = 75	Mixed Syndrome n = 22	No Lipoatrophy n = 203	P Value
Age, y
≤42	46 (61.3)	5 (22.7)	143 (70.4)	<.05
>42	29 (38.7)	17 (77.3)	60 (29.6)
Sex
Female	40 (53.3)	21 (95.4)	146 (71.9)	.002
Male	35 (46.7)	1 (4.6)	57 (28.1)
BMI, kg/m²
≤25	63 (84)	7 (31.8)	110 (54.2)	<.05
>25	12 (16)	15 (68.2)	93 (45.8)

Abbreviation: BMI, body mass index.
^aN = 300.

Table 3. Therapeutic Factors Associated with Different Types of Lipoatrophy. ^a
Associated Factors	Isolated Lipoatrophy n = 75	Mixed Syndrome n = 22	No Lipoatrophy n = 203	P Value
HAART duration, month
≤54	20 (26.7)	9 (40.9)	83 (40.9)	.08
>54	55 (73.3)	13 (59.1)	120 (59.1)
Antiretroviral medications
Zidovudine: yes	33 (44)	9 (40.9)	120 (59.1)	.03
Zidovudine: no	42 (56)	13 (59.1)	83 (40.9)
Stavudine: yes	38 (50.7)	13 (59.1)	56 (27.6)	.0001
Stavudine: no	37 (49.3)	9 (40.1)	147 (72.4)
Protease inhibitor: yes	9 (12)	8 (36.4)	30 (14.8)	.01
Protease inhibitor: no	66 (88)	14 (63.6)	173 (85.2)