Lipodystrophy syndrome(s)

November 2001     View PDF     En español

What the studies tell us

A study of 306 women showed that enlargement of the breasts and waist and wasting of the butt, thighs, and calves were reported in 32 women (10.5%). All who reported fat changes used a regimen with 3TC. Twelve of the 32 women took double combination therapy (including 3TC) that did not include a protease inhibitor. Additionally, among women taking 3TC, the risk of developing changes in body shape was significantly lower in those also taking AZT and higher in women taking d4T.

The study suggests a strong association between body shape changes and using 3TC, whether they had taken a protease inhibitor or not. While far from confirmed, these data suggest that the mechanism causing body shape changes in women may not be related to protease inhibitors. Unlike in men, in women there seems to be a strong connection between 3TC and d4T use and lipodystrophy.

An Italian study included 92 men and 96 women, none of whom had used a protease inhibitor or non-nucleoside (NNRTI). In this study 26% of women and about 7% of men experienced changes in body shape, showing that these changes do not strictly relate to using protease inhibitors. Women had a five times higher risk of fat changes, with the largest differences being breast enlargement (14.6% women, 0% men) and loss of weight in legs.

A French study of 624 people (84% men) also showed evidence of gender differences. All participants used three-drug anti-HIV therapy. Breast enlargement was seen in 49% of women and only 15% of men while central obesity was observed in 67% of women and 48% of men.

Another study of 100 people shows that those taking d4T are more likely to have fat loss compared to those taking AZT (zidovudine, Retrovir). All the participants had only ever used AZT, ddI (didanosine, Videx) and/or ddC (zalcitabine, Hivid).

During the study, volunteers took 3TC (lamivudine, Epivir) + indinavir (Crixivan) and either AZT or d4T. There was no difference in anti-HIV response, fat accumulation, cholesterol, glucose or triglyceride levels between the two groups after 30 months. However, people on d4T had more fat loss in the arms, legs and buttocks. Seventy percent of people taking d4T experienced some fat loss compared to 43% of people on AZT.

This study found that older age, lower CD4+ cell counts and female gender had an increased risk for fat loss. This is the first study to show that women may be more likely to experience fat loss, while several others have shown that women are more likely to experience fat accumulation than men.

Yet another small study showed that gemfibrozil (Lopid) may help lower triglyceride levels. Thirty-two people with elevated triglycerides and on a protease inhibitor-based regimen participated. All were on a low saturated fat diet and used gemfibrozil or placebo. People taking gemfibrozil had a small reduction in triglycerides, but only one had a return to ‘normal’ levels. There were no changes in cholesterol or glucose for either group.

These results suggest that gemfibrozil alone is insufficient to lower triglycerides, especially in people using protease inhibitors. Gemfibrozil may need to be combined with another lipid-lowering drug for optimal effect.

Other studies, reported in posters at the VII Conference on Retroviruses and Opportunistic Infections, showed similar yet sometimes conflicting results. If fat accumulation proves more common among women, then certain risks like diabetes may also be more common among women. However, it’s important to know that imprecise definitions, inconsistent measurements, and the relatively small number of women who were followed so far, may hamper these studies, like all lipodystrophy studies.