Evaluation of the risk factors associated with lipodystrophy development in a cohort of HIV-positive patients

The prevalence of lipodystrophy in an HIV-infected population and the risk factors associated with body shape changes were analysed in this study. Five hundred and four subjects were included. Among these, 201 (39.9%) had features of lipodystrophy syndrome (cases); 303 (60.1%) constituted the control group. Compared with the control group, the lipodystrophy subjects were different in age (P=0.01); duration of antiretroviral therapy (P<0.001); length of exposure to nucleoside reverse transcriptase inhibitors (NRTIs) (P<0.001) and to protease inhibitors (P<0.001); nadir of CD4 cell count (P<0.001); and value of plasma HIV-RNA before antiretroviral therapy (P=0.008). In a multivariate analysis, length of therapy and a nadir CD4 cell count below 250 cell/mul were associated with an increased risk of lipodystrophy. Among patients with lipodystrophy, isolated fat loss was observed in 46 (23%); isolated fat accumulation in 40 (20%); mixed (loss and accumulation) syndrome in 50 (25%); and isolated metabolic changes in 65 (32%). Subjects with morphological alterations displayed a greater cumulative time of exposure to NRTIs and to protease inhibitors than patients with isolated metabolic alterations. Patients with lipoatrophy had had a greater exposure to stavudine.