HIVAssociated Lipodystrophy: Modifiable Risk Factors in Croatian Patients

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HIV-Associated Lipodystrophy Modifiable Risk
Factors in Croatian Patients

• Christine M. Stanley, B.A.
• Drago Turcinov, M.D.
• George Rutherford, M.D.
• Thomas E. Novotny, M.D.
• Josip Begovac, M.D.

University of California San Francisco Universit
y Hospital of Infectious Diseases, Zagreb, Croatia
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Lipodystrophy and HIV/AIDS

• Anti-retroviral (ARV) related lipodystrophy
• 5-30 of people on protease inhibitors
• Also non-nucleoside reverse transcriptase
  inhibitors (NNRTI)

• Lipohypertrophy dorsocervical fat pad, neck
  circumference, breast, abdominal fat

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Risk Factors for Lipodystrophy (LD)

• Non-modifiable
• Increasing age
• Female gender
• Greater duration of ARV
• Greater body weight before ARV
• Modifiable
• Smoking
• Diet Smaller intake of total protein and total
  dietary fiber while taking ARV

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Study Question Could diet decrease the risk of
LD in HIV/AIDS patients on ARVs?

• Mediterranean Diet
• high intake of legumes, fruits, vegetables, nuts,
  cereals and olive oil
• moderate intake of fish
• low to moderate intake of dairy products
• low intake of meat and poultry
• moderate intake of alcohol
• Population-based Greek study found Mediterranean
  diet protective against death due to coronary
  heart disease and cancer.

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Croatia A Mediterranean and Central European
Country

• Hypothesis HIV/AIDS patients adherent to
  Mediterranean diet will have lower LD risk
• Setting One clinic in Zagreb treats all HIV
  patients in Croatia
• Target group Patients from diverse geographical
  areas with differing diets

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Methods

• 136 patients from HIV clinic of Fran Mihalavic
  Infectious Disease Hospital in Zagreb, treated
  with ARV for at least one year
• LD assessed using patient self-report and
  confirmation by physical exam
• Metabolic data and body measurements obtained on
  all patients.

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Measuring Dietary Adherence

• Food questionnaire included 150 food and beverage
  items
• Usual dietary intake during the preceding year
  was calculated
• 5 Beneficial categories vegetables, legumes,
  fruits and nuts, cereals and fish
• 3 Detrimental categories meat, poultry, dairy
• Moderate alcohol consumption considered
  beneficial
• A ten-point adherence scale dichotomized into
• lt 4 points low adherence
• ? 4 points medium and high adherence

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Results

• 41 of participants had moderate to severe
  lipoatrophy
• 32 of participants had moderate to severe
  lipohypertrophy
• Mediterranean diet score of ? 4 was independently
  associated with a lower risk of lipohypertrophy.

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Risk Factors for LD
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LD and Food Categories

• Men without LD (n108) consumed more fish
  (p0.026), less meat (p0.028) and less vegetable
  oils (p0.024).
• 77 of men without LD vs 47 with LD frequently
  consumed olive oil (p0.002).

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Discussion Lipodystrophy

• LD is common, progressive syndrome in HIV/AIDS
  patients taking ARV
• Changes in fat distribution persist after
  discontinuation of ARV
• LD may be disfiguring and stigmatizing
• Because of cost and availability, patients may
  not have option to change treatment.

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Conclusions

• Diet
• Adherence to Mediterranean diet associated with
  decreased LD risk
• Consuming more fish, less meat, and less
  vegetable oil associated with lower LD risk
• Consuming olive oil associated with lower LD risk.

• Smoking
• Former or current smokers had higher risk of
  lipoatrophy (p0.042)

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Study Limitations

• Cross-sectional design
• Prospective randomization not possible
• Difficult to infer causality due to multiple
  confounders

• Results specific to this patient group and may
  not be generalizable

• Questionable accuracy of retrospective dietary
  information
• LD determined by self-report and physical exam.

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Plitvice Lakes National Park , Croatia
Dr. Josip Begovac, Christine Stanley, Sarah
Gertler, Nancy Gertler