Julia Price1, Jennifer Hoy2, Emma Ridley1, Ibolya Nyulasi1, Eldho Paul3, Ian Woolley2. 1. Nutrition Department, The Alfred Hospital, Commercial Road, Melbourne, Vic. 3004, Australia. 2. Infectious Diseases Department, The Alfred Hospital and Monash University, Melbourne, Vic. 3004, Australia. 3. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
Abstract
UNLABELLED: Background Although it significantly improves HIV-related outcomes, some components of combination antiretroviral therapy (ART) cause lipodystrophy syndrome. The composition of combination ART has changed over time but the impact on lipodystrophy prevalence is unknown. METHODS: One hundred HIV-infected males underwent dual-energy X-ray absorptiometry scanning, serum lipid testing and completed a questionnaire in a cross-sectional study in 2010. Thirty-four participants of a 1998 study cohort were re-evaluated in 2010. The same parameters were used to define and compare lipodystrophy, metabolic syndrome and cardiovascular disease (CVD) risk in the two time periods. RESULTS: In 2010, the prevalence of lipodystrophy was lower when compared with 1998 (53% v. 69%, P=0.012), despite higher mean age (51.8 v. 42.1 years, P<0.0001), duration of HIV (165 v. 86 months, P<0.0001), ART exposure (129 v. 38 months, P<0.0001), CD4+ cell count (601 v. 374 cells µL(-1), P<0.0001) and waist circumference (95.5 v. 89.9cm P<0.0001). Cholesterol (5.0 v. 5.6mmolL(-1), P=0.0001) and triglycerides (1.9 v. 3.7mmolL(-1), P<0.0001) were significantly lower in 2010. Factors associated with an increased risk of lipodystrophy in 2010 were duration of HIV infection and low-density lipoprotein cholesterol, whereas current tenofovir or abacavir use was associated with a decreased risk of lipodystrophy. On multivariate analysis low-density lipoprotein cholesterol (OR, 2.65; CI, 1.4-4.9) remained significant for an increased risk and current tenofovir or abacavir use with reduced risk of lipodystrophy (OR, 0.096; CI, 0.011-0.83). In 2010 there was a higher prevalence of metabolic syndrome (33 v. 28%) and higher median Framingham CVD risk (9.9% (5.7-14.6) v. 8.2% (4.5-12.9). CONCLUSION: Despite ageing and longer duration of HIV infection and ART exposure, the prevalence of lipodystrophy in HIV-infected men significantly declined over a 12-year period. However, a trend exists toward a higher prevalence of metabolic syndrome and increased CVD risk.
UNLABELLED: Background Although it significantly improves HIV-related outcomes, some components of combination antiretroviral therapy (ART) cause lipodystrophy syndrome. The composition of combination ART has changed over time but the impact on lipodystrophy prevalence is unknown. METHODS: One hundred HIV-infected males underwent dual-energy X-ray absorptiometry scanning, serum lipid testing and completed a questionnaire in a cross-sectional study in 2010. Thirty-four participants of a 1998 study cohort were re-evaluated in 2010. The same parameters were used to define and compare lipodystrophy, metabolic syndrome and cardiovascular disease (CVD) risk in the two time periods. RESULTS: In 2010, the prevalence of lipodystrophy was lower when compared with 1998 (53% v. 69%, P=0.012), despite higher mean age (51.8 v. 42.1 years, P<0.0001), duration of HIV (165 v. 86 months, P<0.0001), ART exposure (129 v. 38 months, P<0.0001), CD4+ cell count (601 v. 374 cells µL(-1), P<0.0001) and waist circumference (95.5 v. 89.9cm P<0.0001). Cholesterol (5.0 v. 5.6mmolL(-1), P=0.0001) and triglycerides (1.9 v. 3.7mmolL(-1), P<0.0001) were significantly lower in 2010. Factors associated with an increased risk of lipodystrophy in 2010 were duration of HIV infection and low-density lipoprotein cholesterol, whereas current tenofovir or abacavir use was associated with a decreased risk of lipodystrophy. On multivariate analysis low-density lipoprotein cholesterol (OR, 2.65; CI, 1.4-4.9) remained significant for an increased risk and current tenofovir or abacavir use with reduced risk of lipodystrophy (OR, 0.096; CI, 0.011-0.83). In 2010 there was a higher prevalence of metabolic syndrome (33 v. 28%) and higher median Framingham CVD risk (9.9% (5.7-14.6) v. 8.2% (4.5-12.9). CONCLUSION: Despite ageing and longer duration of HIV infection and ART exposure, the prevalence of lipodystrophy in HIV-infectedmen significantly declined over a 12-year period. However, a trend exists toward a higher prevalence of metabolic syndrome and increased CVD risk.
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