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HIV-Associated Lipodystrophy: Modifiable Risk Factors in Croatian Patients Christine M. Stanley, B.A. Christine M. Stanley, B.A. Drago Turčinov, M.D.*

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Presentation on theme: "HIV-Associated Lipodystrophy: Modifiable Risk Factors in Croatian Patients Christine M. Stanley, B.A. Christine M. Stanley, B.A. Drago Turčinov, M.D.*"— Presentation transcript:

1 HIV-Associated Lipodystrophy: Modifiable Risk Factors in Croatian Patients Christine M. Stanley, B.A. Christine M. Stanley, B.A. Drago Turčinov, M.D.* George Rutherford, M.D. George Rutherford, M.D. Thomas E. Novotny, M.D. Thomas E. Novotny, M.D. Josip Begovac, M.D.* University of California San Francisco *University Hospital of Infectious Diseases, Zagreb, Croatia

2 Lipohypertrophy: dorsocervical fat pad, neck circumference, breast, abdominal fat Lipohypertrophy: dorsocervical fat pad, neck circumference, breast, abdominal fat Lipodystrophy and HIV/AIDS Lipoatrophy: loss of fat from cheeks, arms, thighs, buttocks, shoulders Lipoatrophy: loss of fat from cheeks, arms, thighs, buttocks, shoulders Anti-retroviral (ARV) related lipodystrophy: Anti-retroviral (ARV) related lipodystrophy: 5-30% of people on protease inhibitors 5-30% of people on protease inhibitors Also non-nucleoside reverse transcriptase inhibitors (NNRTI) Also non-nucleoside reverse transcriptase inhibitors (NNRTI)

3 Risk Factors for Lipodystrophy (LD) Non-modifiable Non-modifiable Increasing age Increasing age Female gender Female gender Greater duration of ARV Greater duration of ARV Greater body weight before ARV Greater body weight before ARV Modifiable Modifiable Smoking Smoking Diet: Smaller intake of total protein and total dietary fiber while taking ARV Diet: Smaller intake of total protein and total dietary fiber while taking ARV

4 Study Question: Could diet decrease the risk of LD in HIV/AIDS patients on ARVs? Mediterranean Diet: Mediterranean Diet: high intake of legumes, fruits, vegetables, nuts, cereals and olive oil high intake of legumes, fruits, vegetables, nuts, cereals and olive oil moderate intake of fish moderate intake of fish low to moderate intake of dairy products low to moderate intake of dairy products low intake of meat and poultry low intake of meat and poultry moderate intake of alcohol moderate intake of alcohol Population-based Greek study found Mediterranean diet protective against death due to coronary heart disease and cancer. Population-based Greek study found Mediterranean diet protective against death due to coronary heart disease and cancer.

5 Hypothesis: HIV/AIDS patients adherent to Mediterranean diet will have lower LD risk; Hypothesis: HIV/AIDS patients adherent to Mediterranean diet will have lower LD risk; Setting: One clinic in Zagreb treats all HIV patients in Croatia; Setting: One clinic in Zagreb treats all HIV patients in Croatia; Target group: Patients from diverse geographical areas with differing diets Target group: Patients from diverse geographical areas with differing diets Croatia: A Mediterranean and Central European Country

6 136 patients from HIV clinic of Fran Mihalavic Infectious Disease Hospital in Zagreb, treated with ARV for at least one year; 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; LD assessed using patient self-report and confirmation by physical exam; Metabolic data and body measurements obtained on all patients. Metabolic data and body measurements obtained on all patients. Methods

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

8 Results 41% of participants had moderate to severe lipoatrophy; 41% of participants had moderate to severe lipoatrophy; 32% of participants had moderate to severe lipohypertrophy; 32% of participants had moderate to severe lipohypertrophy; Mediterranean diet score of 4 was independently associated with a lower risk of lipohypertrophy. Mediterranean diet score of 4 was independently associated with a lower risk of lipohypertrophy.

9 Risk Factors for LD

10 LD and Food Categories Men without LD (n=108) consumed more fish (p=0.026), less meat (p=0.028) and less vegetable oils (p=0.024). Men without LD (n=108) consumed more fish (p=0.026), less meat (p=0.028) and less vegetable oils (p=0.024). 77% of men without LD vs 47% with LD frequently consumed olive oil (p=0.002). 77% of men without LD vs 47% with LD frequently consumed olive oil (p=0.002). MeatFishVegetable Oils Dietary intake from 108 men in relation to lipodystrophy

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

12 Diet Adherence to Mediterranean diet associated with decreased LD risk; Adherence to Mediterranean diet associated with decreased LD risk; Consuming more fish, less meat, and less vegetable oil associated with lower LD risk; Consuming more fish, less meat, and less vegetable oil associated with lower LD risk; Consuming olive oil associated with lower LD risk. Consuming olive oil associated with lower LD risk. Smoking Former or current smokers had higher risk of lipoatrophy (p=0.042) Former or current smokers had higher risk of lipoatrophy (p=0.042) Conclusions

13 Cross-sectional design Cross-sectional design Prospective randomization not possible Prospective randomization not possible Difficult to infer causality due to multiple confounders Difficult to infer causality due to multiple confounders Study Limitations Results specific to this patient group and may not be generalizable; Results specific to this patient group and may not be generalizable; Questionable accuracy of retrospective dietary information; Questionable accuracy of retrospective dietary information; LD determined by self-report and physical exam. LD determined by self-report and physical exam.

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


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