Lipodystrophy Following HAART in Acute HIV: Study Finds Better Response to HAART May Be Associated With Lipodystrophy
     Reported by Jules Levin

Goujard and a French research group (abstract 403) found in this study reported at the 8th Annual Retrovirus Conference that lipodystrophy can occur in patients starting HAART during primary infection and symptoms of lipodystrophy can occur at 36 months after starting therapy. This is not the first study reporting the observation that lipodystrophy can develop after starting initial therapy in early disease.

In this study, physical exams were used to assess lipodystrophy (face, limbs, belly, breast, arms, legs, trunk). 121 patients were treated during primary infection with a protease inhibitor HAART regimen. 22 (18%) of patients had at least one sign of lipodystrophy after an average of 24 months follow-up. The cumulative incidence of lipodystrophy was 6% at 12 months, 18% at 24 months, and 30% at 36 months. Significantly higher CD4 & CD8 cell counts were seen at the last visit in the patients with lipodystrophy than those without lipodystrophy

As well, patients with lipodystrophy had a lower HIV viral load than patients without lipodystrophy. The authors said that before starting therapy patients viral load & CD4/CD8s and other demographic data were comparable, except that patients with lipodystrophy had higher CD8s 1326 vs 922). The average CD4 count at the last visit was 1006 in the patients with lipodystrophy and 736 in the patients without lipodystrophy. The average CD8 count was 868 for lipodystrophic patients vs 699 for non-lipodystrophic patients.

The average viral load was 1 log in patients with lipodystrophy vs 1.7 log in patients without lipodystrophy. This suggests that patients with a better response to therapy may be more prone to develop lipodystrophy. This in turn suggests that the process related to a higher degree of immune reconstitution may play a role in developing lipodystrophy. The author concluded that because these patients only had HIV for no more than 3 years, these findings argue against the sole role HIV itself in leading to lipodystrophy.