Gender and race differences in lipodystrophy symptoms
Simon Collins, HIV i-Base
The prevalence, type and severity of lipodystrophy in the Ontario Cohort Study was assessed using the ACTG body image questionnaire.
Results from a cohort study of 746 Canadian patients on stable HAART confirmed previously reported side effect profiles in relation to gender and race.
This was a largely male (85%) and non-Black (85%) study. Median age was 48 years (IGR 42-55) and median duration of HIV infection was 13 years (IQR 7-18).
The overall prevalence of 58% lipodystrophy was similar by gender and race. However, men reported fat loss more frequently than women (31% vs 11%, p<0.0001), especially in the face (45% vs 30%, p=0.03) but similarly in the legs and buttocks. Women were more likely to report central fat accumulation (26% vs 15%, p<0.0001) especially in the abdomen (5% vs 46%, p<0.001) and breasts (31% vs 17%, P<0.0001). Women were almost twice as likely to report both symptoms (21% vs 12%, p<0.0001).
The study reported no differences by race (Black vs non-Black) for men, but Black women had a significantly higher rate of fat accumulation than non-Black women (57% vs 38%, p=0.05).
Although there are limitations in this study in terms of limited racial and gender balance, and reliance on personal perception, the overall observations are important for sensitivity of individual patient management. This is especially true as no combination has been identified that has not been associated with fat accumulation, including studies with recently approved lipid-friendly protease inhibitors or with raltegravir.
The associated between lipohypertrophy, gender and race deserves further study.
Ref: Loutfy M et al. Gender and ethnicity differences in body change and distress of HIV-positive individuals taking antiretroviral therapy in Ontario. 11th Intl Workshop on Adverse Drug Reactions. 26-28 October 2009, Philadelphia. Poster abstract P-08. Antiviral therapy 2009; 14 Suppl 2: A29.