Lipodystrophy among patients on antiretroviral therapy at Harare City Opportunistic Infections Clinics, 2010

Abstract

Objective: To determine factors associated with lipodystrophy among patients on anti-retroviral therapy (ART) at Harare City Opportunistic Infections Clinics Design: Unmatched 1:1 case control study Setting: Two ART initiating and referral hospitals belonging to Harare City Health Department in Zimbabwe Subjects: Patients aged 12 years and above on ART at Harare City health facilities for at least 18 months Main outcome measures: Type and severity of lipodystrophy, factors associated with lipodystrophy Results: Out of all participants females constituted 84.3% of cases and 71.9% of controls. The median duration on ART was 48 months (Q1=25; Q3=61) for cases and 35.5 months (Q1=25; Q3=46) for controls. Lipodystrophy affected the legs in 194 (92.38%) cases. The most common type in females was the mixed type (74.8%) and lipoatrophy (53.13%) in males. Of the cases 150 (71.43%) perceived their condition as severe. The median HIV Outpatients Survey (HOPS) scale for the legs and buttocks each was 3 (3; 3). When lipodystrophy developed 197 (93.81%) cases were on a stavudine based combination and 11 (5.24%) on a zidovudine based combination. iii Factors associated with lipodystrophy were a stavudine based regimen (OR=9.84; 95% CI 5.47-16.44), difference between first repeat and baseline CD4 above 400 (OR=5.18; 95% CI 1.95-13.78), age above 40 years (OR=2.47; 95% CI 1.46-4.29), duration after testing HIV positive greater than 4 years (OR=2.37; 95% CI 1.43-3.94), WHO stage at initiation above 2 (OR=2.17; 95% CI 1.29-3.66), female sex (OR=2.16; 95% CI 1.29-3.59) and a baseline CD4 below 100 (OR=2.16; 95% CI 1.29-3.59). A baseline BMI below 20 (OR=0.53; 95% CI 0.31-0.91) was protective. Conclusion: Stavudine based regimen was the most significant factor. Patients belonging to the high risk groups should not be initiated on stavudine whilst those already on stavudine