Lipodystrophy & Women: how long after starting therapy does it take for lipodystrophy to develop; what is the probability of its development?

Also see 'Fat Redistribution and Metabolic Disturbances" written by Dr Graeme Moyle, MD, Associate Director of HIV Research, Chelsea and Westminster Hospital, London, UK.

In an observational study in a cohort of female patients recruited since Nov '97, Galli and others from the University of Milan looked at low long it takes for lipodystrophy to develop. The cumulative probability of developing fat tissue alterations in PI-treated patients (considering also the pre-period of treatment) was 29.8% after one year of follow-up. And, 44.4% after two years. The probability of developing lipodystrphy was 7.1% after 1 year and 10% after 2 years. At study enrollment fat-tissue alteration was present in 39/321 (12%). Fat redistribution was present in 36/39 (92%) while lipodystrophy was observed in only 2 cases. By April 1999, 107/309 (34%) still in follow-up had fat tissue alteration: 53 patients had fat redistribution, 25 had fat accumulation, and 28 had lipodystrophy. So fat redistribution was most prevalent.

For individuals who were treated with only 2 NRTIs, Galli reported that an intent-to-treat analysis did not show after 1 year of follow-up evidence of significantly different cumulative probability of developing fat tissue alteration between patients treated with AZT containing and d4T containing regimens (21% vs 28%).The incidence of lipodystrophy in the 2 groups was 5.5% vs 8.5%. In a different study (abstract 20) the frequency of lipodystrophy was higher in combination regimens containing d4T (54%) than regimens containing AZT (30%). The authors stated the mean duration of ART was longer in d4T (48 mos.) than in AZT recipients (38 mos.) but the difference was of borderline significance (p=0.07). The different findings highlight the difficulty in interpreting the collective of studies on lipodystrphy reported at Retrovirus and in general. Often, the findings, definitions of lipodystrophy, and study designs are different, between studies. It is difficult to define prior treatment and nucleoside experience, making interpretations impossible.