How common is lipodystrophy?

There are still widely differing estimates of the incidence of body fat changes among people on HAART. These variances are largely due to the lack of a standard definition: definitions have been investigator-driven and varied widely between studies. Several studies have found a very high incidence:

  • An Australian study from 2001: 83% of people on PIs experienced some symptoms of lipodystrophy after 21 months of therapy, while 11% experienced severe body fat changes.1
  • A review of 624 French patients who had been taking at least one PI for an average of 18 months found that 85% had experienced at least one physical change during that time: increased abdominal wall thickness, enlargement of veins in the legs and arms, increased waist size, and wasting of the lower limbs and/or buttocks (each reported by 38-48% of the patients).

Many other studies have found somewhat lower results. Some of the representative findings, in approximate order of prevalence, are:

  • The French APROCO cohort: after 12 to 20 months of treatment, a 21% prevalence of fat loss in the face and limbs; 17% fat accumulation and 24% mixed fat loss and fat accumulation. 2
  • The Multicenter AIDS Cohort Study (MACS): 25% to 35% of HIV-positive men lost fat in the face, arms and legs, compared to 2% of the HIV-negative group. Fat accumulation was equally common in both groups. The combination syndrome of a fat belly plus thinning of the arms and/or legs occurred in 20% of the HIV-infected men and only 1% of the negative men. 3
  • At an HIV clinic in Pune, India: lipoatrophy was seen in 26% of the patients taking d4T, 3TC and nevirapine, and 10% of those taking AZT, 3TC and nevirapine, after a median of 18 months. Fat accumulation was found in 10% of the d4T-treated patients and 6% of the AZT-treated patients. 4
  • A cross-sectional analysis (the Aquitaine Cohort) conducted in January 1999: 38% of 581 people on treatment had lipodystrophy - 16% with peripheral fat loss, 12% with fat accumulation, and 10% with both. 5
  • The FRAM study (see above): 40% of men with HIV had developed lipoatrophy.
  • One German study found body fat changes in 50% of people on HIV treatment within two years of starting treatment; 6 another found lipodystrophy in 34% after three years of treatment. 7
  • An Australian survey of 724 patients conducted in 2000 found that the most frequently affected body parts were the face (45%), the legs (43%), the abdomen (39%), the arms (39%) and the buttocks (36%). When the group looked at 1348 consecutive patients seen at Australian HIV clinics during the first five months of 2000, they found that 54% had body fat changes. Of these, 52% had both peripheral and central fat changes, 37% had fat wasting only, and 11% had fat accumulation only. Of particular note is the fact that 21% of the antiretroviral-naive patients had body fat changes, suggesting that some body fat changes may be confused with changes due to ageing or HIV infection itself.
  • A cross-sectional French study of 685 HIV-infected people on treatment in early 1999: 59% had lipodystrophy, including 63 who had never received a protease inhibitor. 8

References

  1. Carr A et al. A HIV protease inhibitor substitution in patients with lipodystrophy: a randomized, controlled, open-label, multicentre study. AIDS 15: 1811-1822, 2001
  2. Saves M et al. Factors related to lipodystrophy and metabolic alterations in patients with human immunodeficiency virus infection receiving highly active antiretroviral therapy. Clin Infect Dis 34: 1396-1405, 2002
  3. Kingsley L et al. Prevalence of lipodystrophy and metabolic abnormalities in the Multicenter AIDS Cohort Study (MACS). Eighth Conference on Retroviruses and Opportunistic Infections, Chicago, abstract 538, 2001
  4. Pujari SN et al. Lipodystrophy and dyslipidemia among patients taking first-line, World Health Organization-recommended highly active antiretroviral therapy regimens in western India. J Acquir Immune Defic Syndr 39: 199-202, 2005
  5. Thiebaut R et al. Lipodystrophy, metabolic disorders, and human immunodeficiency virus infection: Aquitaine Cohort, France, 1999. Groupe d'Epidemiologie Clinique du Syndrome d'Immunodeficience Acquise en Aquitaine, 2000
  6. Bogner JR et al. Stavudine versus zidovudine and the development of lipodystrophy. J Acquir Immune Defic Syndr 27: 237-244, 2001
  7. Mauss S et al. Risk factors for the HIV-associated lipodystrophy syndrome in a closed cohort of patients after 3 years of antiretroviral treatment. HIV Medicine 3(1): 49-55, 2002
  8. Boufassa F et al. Lipodystrophy in 685 HIV-1-treated patients: influence of antiretroviral treatment and immunovirological response. HIV Clin Trials 2: 339-345, 2001
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

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We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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