Latino HIV Patients Starting Antiretroviral Therapy Are Most Likely, and Blacks Are Least Likely, to Develop Lipodystrophy

Body shape changes and metabolic abnormalities -- collectively known as lipodystrophy syndrome -- is common in people with HIV, but it is not yet fully understood whether this is an effect of HIV infection itself, a side effect of antiretroviral therapy, or due to some combination of factors. It is also unclear whether race/ethnicity influences lipodystrophy among HIV positive patients, though it is recognized that metabolic disorders such as diabetes are more common among certain groups in the general HIV negative population.

To address this question, Cynthia Gibert and colleagues with the Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA) and the International Network for Strategic Initiatives in Global HIV Trials assessed long-term changes in metabolic parameters and body composition according to race/ethnicity among treatment-naive patients starting antiretroviral treatment.

As reported in the January 1, 2009 Journal of Acquired Immune Deficiency Syndromes, the researchers compared changes in 398 participants initiating combination antiretroviral therapy in the FIRST (Flexible Initial Retrovirus Suppressive Therapies) study. About 60% (n = 243) were self-identified African-American, about 30% were white (n = 112), and about 10% were Latino (n = 43); overall, 22% were women.

Fasting metabolic parameters were assessed at baseline and at 1-month intervals, and anthropometric measurements were assessed at 4-month intervals. Rates of change over time and overall mean changes from baseline were compared.

Results

Latino patients experienced the greatest increase in glucose levels and insulin resistance.

Latinos also experienced the greatest loss of mid-arm and mid-thigh subcutaneous tissue.

On average, mid-arm and mid-thigh non-subcutaneous tissue increased in all racial/ethnic groups.

Waist subcutaneous fat decreased only among Latinos.

Visceral fat increased the most in Latino and white patients.

For all groups, high-density lipoprotein (HDL or "good") cholesterol levels increased initially, and this increase was sustained.

Low-density lipoprotein (LDL or "bad") cholesterol also increased initially in all groups, but this was followed by a gradual decline.

Triglyceride levels increased in all groups, with the increase being the smallest among African-Americans

Based on these findings, the study authors concluded, "In this prospective long-term evaluation, changes in metabolic parameters and body composition varied across race groups. Latinos experienced the most unfavorable changes."

They recommended that, "Such changes should be monitored over time as the identified differences may impact antiretroviral therapy selection."

In their discussion, the authors wrote that the greater changes in body composition over time and the more unfavorable metabolic parameters observed among Latino patients may reflect not only the impact of HIV infection and antiretroviral therapy, but "also different genetic predisposition," given that similar differences are also seen among HIV negative Latinos.

They also noted that drugs associated with lipodystrophy -- including stavudine (d4T; Zerit), which has been linked with peripheral fat loss or lipoatrophy -- are less commonly used today than when the study was conducted, at least in wealthy countries.

Wide-Reaching AIDS Program, Washington, DC; Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC; Denver Community Programs for Clinical Research on AIDS, Denver, CO; University of Colorado Denver, Denver, CO; University of Minnesota, Minneapolis, MN; Veterans Affairs Medical Center, San Francisco, CA; University of California, San Francisco, CA.

1/23/09

Reference

C Gibert, J Shlay, S Sharma, and others (Terry Beirn Community Programs for Clinical Research on AIDS and the International Network for Strategic Initiatives in Global HIV Trials). Racial Differences in Changes of Metabolic Parameters and Body Composition in Antiretroviral Therapy-Naive Persons Initiating Antiretroviral Therapy. Journal of Acquired Immune Deficiency Syndromes. 50(1): 44-53, January 1, 2009. (Abstract).