Italian researchers have shown that people who adhered better to their antiretroviral therapy were at much higher risk of developing body fat alterations than people who did not always take their medication at the prescribed intervals, in a study published online this week by the Journal of Acquired Immune Deficiency Syndromes in a special supplement on adherence to anti-HIV therapy.
The LipoICONA cohort enrolled 207 patients receiving antiretroviral therapy and assessed adherence at baseline, and evaluated adipose tissue alterations and adherence every six months thereafter. Adherence was assessed by asking patients whether they had missed doses on the previous day, in the previous week, two weeks previously or three to four weeks previously. Adipose tissue alterations were assessed by patient questionnaire and by physician evaluation of fat distribution. Plasma drug concentrations were also measured.
All patients were receiving highly active antiretroviral therapy (HAART) and 74% were receiving a PI-containing regimen. The median prior duration of therapy was 89 weeks, with 37 weeks on the current HAART regimen.
Sixty two per cent of patients reported non-adherence in the previous month, and 25% had a clinical diagnosis of adipose tissue alteration at baseline.
During a median follow-up of 45 weeks, a significantly larger proportion of patients who were adherent at baseline developed adipose tissue alterations when compared to non-adherent patients (43% vs 18%, p=0.007), an adjusted hazard ratio of 2.58 (p=0.03).
“The median time to the development of adipose tissue alterations was five times shorter in those with good adherence”, the authors reported.
Even after controlling for gender, age, mode of HIV transmission, duration of exposure to every antiretroviral drug, ever having an HIV RNA level below 500 copies/ml, plasma concentration score for PIs or NNRTIs and most recent cholesterol and triglyceride score, the relationship persisted.
Men who acquired HIV through sex with other men were significantly more likely than injecting drug users to develop adipose tissue alterations (HR 4.30, p=0.02), and those whose viral load decreased below 500 copies/ml were also significantly more likely to develop adipose tissue alterations (HR 18.49, p=0.02).
However, this study did not adjust for CD4 cell nadir or baseline CD4 count in the regression analysis, even though another analysis of the LipoICONA cohort has shown that the risk of fat loss (although not of a mixed syndrome of fat accumulation and fat loss) was significantly greater in individuals with baseline CD4 cell counts below 200 cells/mm3.
The study also found that fat accumulation (but not the mixed form of lipodystrophy) was associated with an increased risk of non-adherence (odds ratio 4.67), and that duration of therapy was associated with non-adherence (OR 1.84 per year of therapy).
Ammassari A et al. Relationship between HAART adherence and adipose tissue alterations. Journal of Acquired Immune Deficiency Syndromes 31: S140-S144, 2002.