Abstract:

Background: Due to the increase in availability and accessibility of antiretroviral therapies (ARTs) worldwide there has been an increase in the prevalence of long term side effects including human immunodeficiency virus (HIV) lipodystrophy and lipid metabolism abnormalities among patients. Several risk factors have been linked including increasing age, sex, changes in body mass index (BMI), waist hip ratio (WHR), low CD4 count, and the type and duration of ARTs the HIV patient is using, especially protease inhibitors (PIs) and nucleoside reverse transcriptase inhibitors (NRTIs). Little is known about the magnitude and predictors of the disease in Tanzania despite the reported increase in frequency in the west as well as in other parts of Africa.

Objectives: The objective of this study was to determine the prevalence and predictors of lipodystrophy and lipid metabolism disorders among HIV-infected adults attending Bugando Medical Centre (BMC).

Methodology: This was an analytical cross-sectional study, which was conducted at the Bugando Medical Centre (BMC) Care and Treatment Clinic (CTC) between November 2012 and March 2013, comparing both HIV-positive ART-naïve patients and HIV-positive patients on ART for more than 2 years with HIV-negative controls. Clinical features of lipoatrophy and lipohypertrophy were assessed, and blood tests for measurement of lipid levels were taken after more than eight hours of fasting and compared with standard clinical definitions.

Results: A total of 461 participants (153 HIV-positive on ART for 2 or more years, 153 HIV-positive ART-naïve and 155 HIV-negative controls) were enrolled into the study. Most of them (77.1%) were female and the median age was 40 years [38-47]. Clinical risk factors were noted in association with dysilipidemia among the participants enrolled in our study. Central obesity (68%) was common, as well as obesity especially among HIV-positive on ARTs (13.7%). A majority (62.1%) of the patients was using zidovudine based regimens and had CD4 counts higher than 200cells/mm3 (87.6%). The prevalence of lipodystrophy and any dyslipidemia in this study were 21.6% and 71.2% respectively with most affected individuals being HIV-positive on ARTs for more than two years. Stavudine use was found to be the most common predictor for both conditions after multivariate analysis (p<0.001 for lipodystrophy and p<0.016 for dyslipidemia).

Conclusion and Recommendations: The magnitude of lipodystrophy and dyslipidemia is high in our settings especially among HIV-infected patients on ARTs for more than two years and especially those on Stavudine containing regimens. There is a need for routine screening and management of lipodystrophy and dyslipidemia for all HIV-infected patients attending the HIV clinic before and after ART initiation, including changing ARTs to non-Stavudine based regimens.