Risk of Lipodystrophy in HIV-1-Infected Patients Treated with Protease Inhibitors: A Prospective Cohort Study [Martinez E, et al. Lancet 2001;357:592]: This is a report from London concerning the frequency of lipodystrophy based on observations of fat redistribution in 494 patients receiving a PI-based HAART regimen. The definition of lipodystrophy was the perception of body-fat changes sufficiently severe to be recognized by both the patient and the physician; a third person was required if there was disagreement between the patient and physician. Based on this definition, lipodystrophy was detected in 85 (17%) of the patients at a median follow-up of 18 months. Of the 85, 18 (21%) had only central obesity, 29 (34%) had lipoatrophy, and 38 (45%) had both. There was an increased risk among women (OR = 1.87).
Comment: This is a relatively unique paper because it used a definition of lipodystrophy based on subjective observations rather than gadgetry, which makes sense given that lipodystrophy is a cosmetic complication. The definition employed here is certainly practical for broad application. Perhaps most important and distressing were the trend data. The frequency of lipodystrophy progressed substantially with duration of HAART: It was only about 3% at 12 months, 17% at 18 months, and 23% at 24 months. The authors estimated an increased risk of 61% for each additional six months of HAART. There was no significant association with individual antiretroviral agents or with hyperlipemia.
posted 3/8/2001

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