Central fat accumulation remains a significant problem in patients starting HAART after 2005 with higher incidence in women compared to men

21 February 2010. Related: Conference reports, Women's health, Side effects, Lipodystrophy and metabolic complications, EACS 12 Cologne 2009.

Simon Collins, HIV i-Base

A cross-sectional study from two large French hospitals presented at EACS was important for confirming that central fat accumulation (CFA), one of the symptoms associated with HIV-related lipodystrophy, remains a significant side effect, even for patients who have started treatment recently.

Isabelle Poizot-Martin and colleagues used waist circumference as a surrogate marker of CFA in 838 HIV-positive patients (71% male, 29% female) who started combination antiretroviral therapy (cART) before (Group 1, n=723) or after January 2005 (Group 2, n=115). CFA was defined as >102/88 cms (using NCEP ATPIII guidelines) or >94/80 cms (using IDF classification), for men/women respectively.

Median age (years) was 46 in Group 1 and 44 in Group 2 (p=0.004). Median CD4 count was 523 and 472 cells/mm3, respectively (p=0.06) and viral load was <40 copies/mL in 84% of patients in each group. Exposure to cART was 11.6 vs 2.1 years for Group 1 and 2 respectively.

CFA was reported in significantly higher rates for women compared to men in both groups, but also at higher rates in women who started treatment after 2005 compared to women who started treatment earlier, as detailed in Table 1.

Table 1: Percentages of patients with CFA diagnosed by waist circumference

* p=0.028 ** p=0.013 (between group comparisons)

While there were significant differences in use of different drugs in Group 1 compared to Groups 2 (mainly a higher use of triple-nucleoside regimens: by 11 vs 2% of patients), there were no significant differences by sex, particularly for Group 2.

COMMENT

While further associations are limited in a single cross-sectional dataset, the conclusion that CFA remains highly prevalent in patients who started treatment recently, is important.

The different rates of CFA in women compared to men had been previously reported and clearly warrant further study. The results support the
importance for every new antiretroviral to include prospective monitoring of body fat changes within Phase 3 studies. It is difficult to understand how
any new drug could be approved without data on the impact it has on lipodystrophy and body fat changes.

Ref: Poizot-Martin I et al. Abdominal adiposity remains highly prevalent in French HIV-infected patients having initiated antiretroviral therapy after
2005. 12th EACS. 11-14 November 2009, Cologne. Abstract PS11/1.