| Summary: | Objectives: The primary objectives of this study are to determine the prevalence and
incidence of the emerging lipid and morphologic abnormalities commonly referred to as
human immunodeficiency virus (HlV)-associated lipodystrophy syndrome and to identify
possible determinates of prevalent and accrued symptoms among persons receiving treatment
for HIV infection in British Columbia. We also aim to describe both physician and patient
responses to the occurrence of these and other adverse drug effects particularly in relation to
pro-active antiretroviral regimen non-adherence among patients.
Methods: British Columbia's provincial HIV/AIDS Drug Treatment Program provides
antiretroviral therapy to all eligible HIV positive persons in British Columbia free of charge.
Persons prescribed antiretroviral agents are automatically entered into the drug treatment
program database and information regarding prescribed therapies, age, gender, AIDS status
and laboratory parameters is maintained for all participants while they remain on therapy. In
addition, subjects complete voluntary surveys each year on the occasion of their anniversary of
treatment program entry. This captures detailed information regarding socio-demographic
characteristics, the occurrence of adverse drug effects, and other parameters. Additional
questions regarding medically unsanctioned antiretroviral therapy adjustment and other
responses to the occurrence of sub-types of adverse drug effects were incorporated for one
year of the survey.
Results: The prevalence of probable HIV-associated lipodystrophy syndrome in British
Columbia among antiretroviral recipients is approximately 50% by self-report. Incidence rates
of symptoms are also high among both those with an extensive history of therapy and those
initiating first antiretroviral therapy. Study findings indicate a primary role of protease
inhibitors in the aetiology of symptoms including lipoatrophy, lipohypertrophy and
dyslipidemia. Other factors including patient gender and stavudine use may be related to
morphologic abnormalities. Proactive self medication in direct response to adverse drug
effects occurs at an annual rate of approximately 11%. This activity is associated with the
severity, number and type of symptoms experienced.
Conclusion: Lipodystrophy-associated symptoms are likely a consequence of antiretroviral
therapy although their aetiology is complex and multifactorial. Symptoms associated with
lipodystrophy and other adverse drug effects are likely to prompt intentional regimen
adjustment and require consideration beyond their direct impact on clinical outcomes.
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