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Risk of Developing Lipodystrophy Linked to HAART Regime Duration
Lipodystrophy, or irregular fat deposits, is a possible side effect of highly active antiretroviral therapy, and prolonged use of antiAIDS drug combinations increases its incidence, according to a study published in this week's Lancet. Spanish researchers studied 494 patients who began HAART with at least one protease inhibitor between October 1996 and September 1999 and showed that 17% developed some type of lipodystrophy in a median follow-up of 18 months. Lipodystrophy is marked by the accumulation of fat on the abdomen and upper back and may be combined with the loss of fat in other areas of the body such as the face, limbs and buttocks. Of the 85 patients diagnosed with any lipodystrophy, 21% were diagnosed with central obesity alone, 34% with subcutaneous lipoatrophy and 45% with mixed lipodystrophy. For unknown reasons, women had a higher risk for the condition than men, and those infected with HIV through sexual activities had a greater risk of the condition than drug users infected through unclean needles. Lipodystrophy incidence also increases with age and with duration of HAART, as a 45% increased risk for every six months of drug exposure was reported. After 24 months on HAART, 23% of patients were estimated to have some type of lipodystrophy. In addition, patients with a higher viral load at the initiation of HAART were "significantly more likely to develop" the condition. Although previous research suggested that one of the individual drugs in the cocktail was responsible for the side effect, the researchers ascertained that lipodystrophy did not increase with any one antiretroviral agent. However, HAART regimes without protease inhibitors may not produce the same effects (Martinez et al., Lancet, 2/24). Lead study author Dr. Esteban Martinez said, "Our study suggests that the risk of lipodystrophy is mainly related to the total exposure" to HAART, and "only to a lesser degree to specific antiretroviral drugs." He added, "We have identified risk factors not related to antiretroviral therapy, such as age and sex, that have not received adequate attention until now. Future research should focus on these new risk factors" (Reuters/Boston Globe, 2/23).
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