Body Fat Changes in Treatment-naive Patients on PI- and NNRTI-based HAART in the Swiss HIV Cohort Study: Fat Loss More Likely with Increasing Stavudine Use

Body fat changes are common in patients with HIV. For patients on protease inhibitor (PI)-based HAART these changes have been associated with increasing exposure to therapy in general and to stavudine/ d4T (Zerit) in particular.

The purpose of the current study was to show whether such associations are more or less likely for patients on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART.

Researchers of the Swiss HIV Cohort Study included all antiretroviral-naive patients in the cohort starting HAART after April 2000 who had had body weight, CD4 cell count and plasma HIV RNA measured between 6 months before and 3 months after starting HAART, and at least one assessment of body fat changes after starting HAART.

At visits scheduled every 6 months, fat loss or fat gain is reported by agreement between patient and physician. The investigators estimate the association between reported body fat changes and both time on therapy and time on stavudine, using conditional logistical regression.

Results

·         Body fat changes were reported for 85 (9%) out of 925 patients at their first assessment; a further 165 had only one assessment.

·         Of the remaining 675 patients, body fat changes were reported for 156 patients at a rate of 13.2 changes per 100 patient-years.

·         Body fat changes are more likely with increasing age, with increasing BMI and in those with a lower baseline CD4 cell count per 100 cells/microliter].

·         There is only weak evidence that body fat changes are more likely with increasing time on HAART.

·         After adjusting for time on HAART, fat loss is more likely with increasing stavudine use.

·         There is no evidence of an association between reported fat changes and time on NNRTI therapy relative to PI therapy in those patients who used either one therapy or the other.

The authors conclude, “Fat loss is more likely to be reported with increasing exposure to stavudine. We find no evidence of major differences between PI and NNRTI therapy in the risk of reported body fat changes.

05/23/05

Reference
J Young and others (the Swiss Cohort Study). Body fat changes among antiretroviral-naive patients on PI- and NNRTI-based HAART in the Swiss HIV Cohort Study. Antiviral Therapy 10: 73-81. 2005.

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