Clinical and biochemical evaluation of HIV-related lipodystrophy in an ambulatory population from the Hospital Universitário Cassiano Antonio de Morais, Vitória, ES, Brazil

Abstract

We designed a retrospective cohort study to identify factors associated with HIV-1 related lipodystrophy at a tertiary HIV-care center in Vitória, ES, Brazil. Inclusion criteria were documented HIV diagnosis, anti-retroviral therapy and age above 17 years. Highly active antiretroviral therapy (HAART) was initially the exposure variable, but a second analysis was also performed, as a nested case-control, based on the presence or absence of lipodystrophy. Use of protease inhibitors (PI) was associated with an increase in serum triglycerides (243.7 +/- 189 mg/dL vs. 172.7 +/- 131 mg/dL, p = 0.015), but not of total cholesterol (TC) or HDL fraction levels. Non-nucleoside reverse transcriptase inhibitors (NNRTI) were associated with an increase in serum TC (180.6 +/- 46.8 mg/dL versus 162.4 +/- 41.4 mg/dL; p= 0.018) and an increase in HDL cholesterol (47.3 +/- 13.8 mg/dL versus 23.3 +/- 24.3 mg/dL; p< 0.001), with no significant effect on triglyceride levels. Lipodystrophy was diagnosed in 59.3% of the patients, but exposure to PI versus NNRTI did not affect the frequency of this disorder (43.4% versus 37.2%; p = 0.68). Serum TC, but not HDL cholesterol or triglyceride levels, was higher among the lipodystrophy cases (183.8 +/-47.5 mg/dL versus 162.1 +/-35.7; p=0.006). Among the controls (patients without lipodystrophy), HDL cholesterol (45.3 +/-14.4 mg/dL vs. 27.1 +/-26.3; p=0.001)and triglyceride levels (178.3 +/-146.3 mg/dL vs. 126.3 +/-126.9; p=0.013) also increased, but not TC. In conclusion, lipodystrophy was highly prevalent in our series. Lipid disorders were also frequent and apparently were related to lipodystrophy, except for triglyceride levels.

Prevalence of HIV-Associated Lipodystrophy in Brazil: A Systematic Review of the Literature

“…Patient self-report on changes in body-fat distribution after HIV infection diagnosis associated with clinician examination was the most common method of lipodystrophy assessment in the studies reviewed (n=6) [18,19,23,[26][27][28] and that showed the greatest variation in prevalence rates, from 38.5% [26] to 67.9% [19]. Other methods used for lipodystrophy diagnosis in these studies were patient selfreport alone (n=4) [17,20,21,28]; clinician diagnosis associated with body measurements (n=1) [22]; patient self-report associated with body measurements (n=2) [30,31]; and clinician diagnosis alone (n=2) [24,25].…”

“…Not all the surveyed patients developed lipodystrophy associated with HIV [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], which suggests that lipodystrophy syndrome varies not only with respect to the length of time of the treatment regimen, but also in relation to the effects of systemic chronic inflammatory process resulting from HIV infection itself and factors associated with lifestyle such as physical activity, dietary pattern, and other factors [23,36,37]. There are few studies in the literature comparing these changes with those of non-HIV-infected individuals, because a fat gain can happen with natural aging, or as an immune recovery process after initiation of HAART regimen [38,39].…”

“…Table 1 shows the characteristics of the Brazilian studies included in the review with estimates of prevalence of lipodystrophy in people living with HIV. With regard to the study design, 14 were crosssectional studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], and 1 was a retrospective cohort study [19].…”

“…The remaining papers were intended to assess metabolic changes, and lipodystrophy was a secondary outcome [19][20][21][22][24][25][26][27][28].…”

“…The sample size in the reviewed studies ranged from 42 [23] to1,240 [31]. The overall median age was 40.2 years, with ages ranging from 18 [19] to 78 [24] years. Only one study did not show the median age of the participants [23].…”