Incidence of lipodystrophy in Rwanda
Simon Collins, HIV i-Base
As treatment access programmes, still largely reliant on d4T-based combinations, roll out in resource-limited settings, it is important that safety data are collected and reported, in order to influence access to and use of more modern, tolerable treatment.
Mutimura and colleagues from the Kigali Health Institute reported an incidence of lipodystrophy of 34% in a cohort of 571 patients from Rwanda with >6 months treatment experience. This rose to over 70% in patients who had received HAART for longer than 17 months. In this study, 80% of patients were using fixed dose combination of d4T/3TC/nevirapine.
Selected metabolic parameters from 100 HIV-positive patients with lipodystrophy were compared to 50 non-lipodytrophic patients and 50 HIV-negative controls. Waist circumference and median total cholesterol were higher in patients with lipodystrophy, and impaired glucose tolerance (fasting glucose >5.6 mmol/l) was higher in all patients on HAART compared to the HIV-negative control group (see Table 1).
Table 1: Metabolic parameter of patients on HAART with or without lipodystrophy (LDS) compared to HIV-negative controls
|Waist circumference||86.3 ±6.0||75.9 ±6.1||–|
|Median total cholesterol||3.60||3.19||3.31|
|Fasting glucose >5.6||18%||16%||2%|
In addition to the high rates of lipodystrophy observed in patients using this WHO recommended first-line combination, the study highlighted the importance of anthropomorphic and metabolic parameters in resource poor countries and in particular these markers of risk for future cardiovascular disease and type-2 diabetes mellitus.
Mutimura E, Stewart A, Crowther NJ. The prevalence and metabolic consequences of antiretroviral-associated lipodystrophy in a population of HIV-infected African subjects. 8th IWADRLH, September 2006, San Francisco. Abstract 28.