Characteristics and Factors Associated With the Clinical Forms of Lipoatrophy During Highly Active Antiretroviral Therapy in Ouagadougou, Burkina Faso

Oumar Guira, MD; Hervé Tiéno, MD; Bertille Yaméogo, MD; Arnaud Eric Diendéré, MD; Nina Korsaga, MD; Yempabou Sagna, MD; Lassané Zoungrana, MD; Ismael Diallo, MD; René Traoré, MD; Joseph Youssouf Drabo, MD

Disclosures

J Int Assoc Provid AIDS Care. 2014;13(2):184-187.

Results

Epidemiological and Clinical Features of Lipoatrophy

Three hundred patients were studied; the sex ratio was 0.4 and mean age was 42.1 ± 8.5 years. The mean duration of HAART was 73.2 ± 30.9 months. The main HAART regimens noted were zidovudine (ZDV)/lamivudine (3TC)/nevirapine (NVP) (32.3%); stavudine (d4T)/3TC/NVP (26.3%), and ZDV/3TC/efavirenz (EFV; 14.3%). Of these patients, 97 (32.3%) had lipoatrophy, including 75 (25%) isolated lipoatrophy and 22 (7.3%) mixed syndrome. Thirty-one (10.3%) patients had isolated lipohypertrophy. Table 1 shows the demographic and anthropometric features in different groups of patients.

Lipoatrophy affected the face, lower limbs, buttocks, and upper limbs, respectively, in 60 (61.8%), 22 (22.7%), 21 (21.6%), and 10 (10.3%) patients. Forty-five (46.4%) patients had lipoatrophy with multiple localizations.

Factors Associated With Different Forms of Lipoatrophy

As factors related to lifestyle, smoking was reported by 5 (6.7%) patients who presented with lipoatrophy, 4 (18.2%) with mixed syndrome, and 4 (2%) without lipoatrophy (P = .001). The practice of physical activity was reported by 7 (9.3%) patients with isolated lipoatrophy, 3 (13.6%) with mixed syndrome, and 5 (2.5%) without lipoatrophy (P = .003).

The baseline CD4 count was lower than 200 cells/mm³ in 36 (48%) patients with isolated lipoatrophy, 7 (31.8%) with mixed syndrome, and 105 (51.7%) without lipoatrophy; P = .20. Table 2 and Table 3, respectively, show the demographic and anthropometric and the therapeutic factors associated with different phenotypes of lipoatrophy.

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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)