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Incidence of Adipose Tissue Alterations in First-Line Antiretroviral Therapy
The LipoICoNa Study
Massimo Galli, MD;
Alessandro Cozzi-Lepri, PhD;
Aana Lisa Ridolfo, MD;
Cristina Gervasoni, MD;
Laura Ravasio, MD;
Laura Corsico, MD;
Erika Gianelli, MD;
Mauro Vaccarezza, MD, MSc;
Vincenzo Vullo, MD;
Antonietta Cargnel, MD;
Lorenzo Minoli, MD;
Olga Coronado, MD;
Andrea Giacometti, MD;
Andrea Antinori, MD;
Giorgio Antonucci, MD;
Antonella d'Arminio Monforte, MD;
Mauro Moroni, MD;
for the LipoICoNa Study
Arch Intern Med. 2002;162:2621-2628.
Background Adipose tissue alterations (ATAs) are a frequent untoward effect of antiretroviral therapy, the causes of which remain incompletely explained.
Objectives To assess the incidence of ATAs and to identify the associated risk factors in patients infected with human immunodeficiency virus type 1 starting their first-line antiretroviral treatment.
Methods In a multicenter investigation designed to study issues related to the treatment of patients starting antiretroviral therapy, physicians were requested to assess the presence of ATAs at enrollment and every 6 months thereafter. The ATAs were considered altogether and grouped as fat loss (lipoatrophy), adipose tissue accumulation (lipohypertrophy), and combined forms.
Results A total of 655 patients were followed up for a median of 86 weeks; 128 patients (19.6%) were diagnosed as having at least 1 morphologic alteration during the study. Female gender and positivity for hepatitis C virus were independently linked to an increased risk of developing morphologic alterations. Age was another independent correlate of risk of developing ATAs. To have been infected through drug injection was a correlate of reduced risk of ATAs. Stavudine exposure was predictive at borderline statistical significance of lipoatrophy (but not of the other forms), and indinavir exposure was associated with a significantly higher risk of developing combined forms. Patients who started therapy with 2 nucleoside reverse transcriptase inhibitors and subsequently added a protease inhibitor during the follow-up had a significantly higher risk of having ATAs compared with patients who continued taking 2 nucleoside reverse transcriptase inhibitors up to the end of follow-up.
Conclusions Different types of ATAs might derive from distinct pathways and multifactorial causes. Adipose tissue alterations are a frequent and relatively early finding during first-line antiretroviral therapy.
From the Institute of Infectious Diseases and Tropical Medicine (Drs Galli, Ridolfo, Gervasoni, Ravasio, Corsico, Gianelli, Vaccarezza, d'Arminio Monforte, and Moroni) and II Division of Infectious Diseases and Tropical Medicine (Dr Cargnel), University of Milan, "L Sacco" Hospital, Milan, Italy; Royal Free Centre for HIV Medicine and Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, London, England (Dr Cozzi-Lepri); Infectious Diseases Clinic, Policlinico Umberto I, Università La Sapienza, Rome, Italy (Dr Vullo); Division of Infectious Diseases and Tropical Medicine, Università di Pavia, IRCCS Policlinico San Matteo, Pavia, Italy (Dr Minoli); Division of Infectious Diseases, Ospedale Maggiore, Bologna, Italy (Dr Coronado); Infectious Disease and Public Health Institute, Ospedale Umberto I, Università di Ancona, Ancona, Italy (Dr Giacometti); and National Institute of Infectious Diseases, IRCCS L. Spallanzani, Rome, Italy (Drs Antinori and Antonucci).
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