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Lipodystrophy and Body Weight Changes in the Swiss HIV Cohort Study, 2000-2006

By Ronald Baker, PhD

There is an increasing number of new antiretroviral drugs from existing and new classes available for use by treatment-naive and treatment-experienced HIV patients. This may significantly impact the type and occurrence of drug-related side effects.

In the preset study, published in the February 17, 2008 issue of HIV Medicine, researchers with the Swiss HIV Cohort Study evaluated the frequency of lipodystrophy (fat accumulation and fat loss) and body weight changes in relation to the use of specific drugs in their patients.

The investigators followed cohort participants twice a year and noted whether the patients experienced fat accumulation, fat loss, or neither. The current analysis included all patients treated with HAART between 2003 and 2006 and, in addition, all patients initiating HAART between 2000 and 2003.

Results

• In the period 2003-2006, the percentage of patients taking d4T (stavudine, Zerit), ddI (didanosine, Videx), and nelfinavir (Viracept) decreased.

• The percentage taking lopinavir/ritonavir (Kaletra), nevirapine (Viramune), and efavirenz (Sustiva) remained stable in 2003-2006.

• The percentage taking atazanavir (Reyataz) and tenofovir (Viread) increased by 18.7% and 22.2%, respectively, during this same period.

• By life-table Kaplan-Meier analysis, patients starting HAART in 2003-2006 were less likely to develop lipodystrophy than those starting HAART in 2000-2002 (P < 0.02).

• Lipodystrophy was cited as the reason for treatment change or discontinuation of drug therapy for 4% of patients on HAART in 2003, and for 1% of patients treated in 2006 (P for trend < 0.001).

• In univariate and multivariate regression analyses, patients with a weight gain of greater than or equal to 5 kg were more likely to take lopinavir/ritonavir or atazanavir than patients without such weight gain.

Conclusion

In conclusion, the study authors wrote, "Lipodystrophy has become less frequent in the Swiss HIV Cohort Study from 2000 to 2006," adding that, "A weight gain of more than 5 kg was associated with the use of atazanavir and lopinavir."

Infectious Disease/HIV Unit, University Hospital Geneva, Switzerland.

2/26/08

Reference

A Nguyen, A Calmy, V Schiffer, and others (the Swiss HIV Cohort Study). Lipodystrophy and weight changes: data from the Swiss HIV Cohort Study, 2000-2006. HIV Medicine 9(3): 142-150. February 17, 2008.

Additional Reading

RS Cvetkovic and KL Goa. Lopinavir/ritonavir: a review of its use in the management of HIV infection. Drugs 63(8): 769-802. 2003.

S Abgrall, PG Yeni, O Bouchaud, and others. (Clinical Epidemiology Group from the French Hospital Database on HIV). Switch from a first virologically effective protease inhibitor-containing regimen to a regimen containing efavirenz, nevirapine or abacavir. AIDS 20(16): 2099-2106. October 24, 2006.

S Abgral, PG Yeni, O Bouchaud, and others. Clinical Epidemiology Group of the French Hospital Database on HIV.Comparative biological and clinical outcomes after a switch from a virologically unsuccessful first protease inhibitor-containing antiretroviral combination to a 3-drug regimen containing efavirenz, nevirapine, or abacavir. Clinical Infect Diseases. 44(1): 120-127. January 1, 2007.

MP Dubé, L Komarow, K Mulligan K, and others (ACTG 384).Long-term body fat outcomes in antiretroviral-naive participants randomized to nelfinavir or efavirenz or both plus dual nucleosides. Dual X-ray absorptiometry results from A5005s, a substudy of Adult Clinical Trials Group 384. Journal of Acquired Immune Deficiency Syndrome 45(5): 508-514. August 15, 2007.