Lipodystrophy and Metabolic Disorders in HIV-1-Infected Adults on 4- to 9-Year Antiretroviral Therapy in Senegal: A Case-Control Study

Mercier, Sabine; Gueye, Ndèye Fatou Ngom; Cournil, Amandine; Fontbonne, Annick; Copin, N.; Ndiaye, Ibrahima; Dupuy, Anne‐Marie; Cames, Cécile; Sow, Papa Salif; Ndoye, Ibra; Delaporte, Eric; Bork, Kirsten

doi:10.1097/qai.0b013e31819c16f4

Cited by 59 publications

(52 citation statements)

References 17 publications

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“…We also found a cohesion between the duration of the antiretroviral therapy and the increasing percentages of lipodystrophy cases recorded during our study period (Table 5). Our finding is similar to that found in a large number of lipodystrophy study that also found that long exposure to HAART was associated with lipodystrophy [6,14,25,30,36,37]. The finding evoked in our study could be explained in the literature review which reports that the toxicity of some ARV drugs induces a mitochondrial dysfunction and an oxidative stress that are at the origin of the occurrence of the lipodystrophiy syndrome [31,37].…”

Section: Duration Of Exposure To Antiretroviral Therapysupporting

confidence: 80%

“…Our proportion is somewhat lower than the 37% reported by Thiébaut [6] and the 43.9% reported by Eholié in the Lipo-Afri study [10]. Studies have shown a significant association between the use of protease inhibitors and lipodystrophy among HIV-infected patients [6,14,30]. Indeed, the relationship between protease inhibitors and lipodystrophy is known.…”

Section: The Therapeutic Protocolcontrasting

confidence: 54%

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Prevalence of Lipodystrophy and Metabolic Syndrome at the Bertoua Day Hospital (East Region of Cameroon)

Ndoe

Damdam

Marat

et al. 2017

JAPLR

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This cross-sectional study, carried out on a cohort of 568 HIV-infected patients followed at the Bertoua Day Hospital, aimed at assessing interventions used in the biomedical management of lipodystrophy and metabolic syndrome related to Antiretroviral therapy through the determination of their prevalence within this hospital. Patients had a minimum age of 18years old, a minimum duration of 2years antiretroviral therapy and all had given their informed consent to participate in the study. The mean duration of treatment for HIV patients with lipodystrophy cases was 68±9.2 months ranged from 24 to 136months and that for patients with metabolic syndrome cases was 46±8.5 months ranged from 24 to 151months (P value = 0.005). Lipodystrophy was observed with all the therapeutic protocols prescribed to HIVinfected patients in our study site. Lipodystrophy cases seen among HIV-infected patients using the d4T in their therapeutic protocol accounted for 41.11%, while those seen among HIV-infected patients using the AZT in their therapeutic protocol accounted for 51.57% (P <0.0001). Among HIV-infected patients using the NVP in their therapeutic protocol, we found 40.41% of lipodystrophy cases versus 28.23% of lipodystrophy cases among HIV-infected patients using the EFV in their therapeutic protocol (P value=0.01). Lipodystrophy cases related to the use of protease inhibitors in the therapeutic protocol accounted for 31.36%. The prevalence of metabolic syndrome cases was greatest among HIV-infected patients using protease inhibitors boosted by the ritonavir in their therapeutic protocol with 72.6% of cases (P value = 0.0003). The prevalence of metabolic syndrome cases determined in this study using the definition of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) was 21.83% and that of lipodystrophy cases was 50.52% with 27.64% for lipoatrophy cases, 20.95% for lipohypertrophy cases and 1.93% for mixed syndrome cases (P value = 0.01). We also found 16.9% for lipodystrophy cases strongly associated with the metabolic syndrome among our HIV infected patients under HAART, with an Odds Ratio of 4.54 which was statistically significant with a confidence interval (CI) between 3.45 and 6.87 to 95% (P value = 0.03). In other words, these HIV infected patients were 4.54 times more likely to have a metabolic syndrome in the presence of lipodystrophy than in its absence.

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Section: Duration Of Exposure To Antiretroviral Therapysupporting

confidence: 80%

Section: The Therapeutic Protocolcontrasting

confidence: 54%

Prevalence of Lipodystrophy and Metabolic Syndrome at the Bertoua Day Hospital (East Region of Cameroon)

Ndoe

Damdam

Marat

et al. 2017

JAPLR

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“…These findings are supported by Martin et al [6], who reported that NRTI These results confirmed that new mtDNA sequence alterations could arise within individuals after a period of antiretroviral therapy. LD is one of the common adverse effects of antiretroviral therapy, and lipoatrophy is the most stigmatizing side effect [12]. The basic feature of LD syndromes is a paucity of subcutaneous and other adipose tissue depots and impaired energy storage leading to metabolic alterations.…”

Section: Discussionmentioning

confidence: 99%

NRTIs’ effect on the sequence of mitochondrial DNA HV 2 in HIV infected patients

Chen

Shi

et al. 2010

Front. Med. China

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Potent combination antiretroviral therapy (cART) has significantly improved the life expectancy of people living with human immunodeficiency virus (HIV), but it has many side effects such as lipodystrophy (LD), hepatic steatosis, and lactic acidosis. Nucleoside reverse transcriptase inhibitors (NRTIs) could damage the mitochondria by inhibiting the human DNA polymerase gamma, leading to mtDNA deletion. However, it remains uncertain whether NRTIs could induce the hypervariable region (HV) mutations of the D loop of mitochondria in Chinese HIV/AIDS patients, and whether that effect is different between individuals with and without LD. Hereby, 30 Chinese AIDS patients who were receiving antiretroviral drugs were recruited, among which 16 had symptomatic LD and 14 did not. Blood samples were collected prior to and after 96 weeks of treatment. Total DNA was extracted from peripheral blood mononuclear cells (PBMCs). Fragments of 728 bp in length containing HV 2 were amplified by standard polymerase chain reaction (PCR). Direct DNA-sequencing analysis techniques were used to detect mitochondrial sequence variants between paired longitudinal samples. Alterations were compared with the revised Cambridge Reference Sequence (rCRS) to determine mutation or polymorphism. Results showed that two years after ART, totally seven cases exhibited sequence variations, five individuals showed 73 A ! G revised variation (two with and three without LD), while two cases of LD were found to have other nucleotide alterations. There was no new alteration in individuals without LD. In conclusion, NRTIs could induce mutation of mtDNA HV 2, which might contribute to the development of LD.

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“…Following the introduction of PI, however, a greater number of reported glucose disorders began to emerge in HIV-infected individuals (15,136,137) . Abnormalities in fasting blood glucose concentration have been found in up to 20 % of patients (64,72,74,88) , while prevalence figures for impaired fasting glucose (59,74,75,81,88) and impaired glucose tolerance (57,72,73,81,98,116) have been shown to vary from 3·8 to 18 % and from 7 to 37 %, respectively. In comparison, the prevalence of impaired glucose tolerance and impaired fasting glucose in the general population is 8·4 and 6·3 %, respectively (138) .…”

Section: Glucose Abnormalitiesmentioning

confidence: 99%

Nutrition and the HIV-associated lipodystrophy syndrome

Loonam

Mullen

2012

Nutr. Res. Rev.

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HIV-associated lipodystrophy syndrome (HALS), comprising metabolic and morphological alterations, is a known side effect of highly active antiretroviral therapy (HAART). Evidence for the role of nutrition in the management of the systemic parameters of HALS is currently limited. In the present paper we review the current knowledge base surrounding HALS, focusing particularly on the role of nutrition in mitigating the systemic parameters of the syndrome. Reported prevalence of HALS was found to vary from 9 to 83 % due to lack of a standardised definition, as well as variations in assessment methods and in the study population used. HALS is associated with both morphological (lipoatrophy, lipohypertrophy) and metabolic (dyslipidaemia, glucose intolerance, diabetes, hypertension, endothelial dysfunction and atherosclerosis) alterations, which may occur singly or in combination, and are associated with an increased risk of CVD. HAART-induced adipocyte inflammation, oxidative stress and macrophage infiltration, as well as altered adipocyte function and mitochondrial toxicity, have been shown to be central to the development of HALS. The adipocyte, therefore, represents a plausible target for treatment. Pharmacological and surgical treatment interventions have shown effect. However, their use is associated with numerous adverse effects and complications. Targeted lifestyle interventions may provide a useful alternative for managing HALS owing to their safety and tolerability. A Mediterranean-style diet has been found to be effective in improving the systemic parameters of HALS. Furthermore, the effects of n-3 PUFA supplementation are encouraging and future randomised controlled trials investigating the beneficial effects of n-3 PUFA in HALS are justified.

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Lipodystrophy and Metabolic Disorders in HIV-1-Infected Adults on 4- to 9-Year Antiretroviral Therapy in Senegal: A Case-Control Study

Abstract: Moderate-severe lipodystrophy affected one third of West African patients on long-term HAART and was associated with a less favorable metabolic profile.

Cited by 59 publications

References 17 publications

Prevalence of Lipodystrophy and Metabolic Syndrome at the Bertoua Day Hospital (East Region of Cameroon)

Prevalence of Lipodystrophy and Metabolic Syndrome at the Bertoua Day Hospital (East Region of Cameroon)

NRTIs’ effect on the sequence of mitochondrial DNA HV 2 in HIV infected patients

Nutrition and the HIV-associated lipodystrophy syndrome

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