Presentation on theme: "Christine M. Stanley, B.A. † Drago Turčinov, M.D.*"— Presentation transcript:
1HIV-Associated Lipodystrophy: Modifiable Risk Factors in Croatian Patients Christine M. Stanley, B.A. †Drago Turčinov, M.D.*George Rutherford, M.D. †Thomas E. Novotny, M.D. †Josip Begovac, M.D.*†University of California San Francisco*University Hospital of Infectious Diseases, Zagreb, Croatia
2Lipodystrophy and HIV/AIDS Anti-retroviral (ARV) related lipodystrophy:5-30% of people on protease inhibitorsAlso non-nucleoside reverse transcriptase inhibitors (NNRTI)Lipohypertrophy: dorsocervical fat pad, neck circumference, breast, abdominal fatLipoatrophy: loss of fat from cheeks, arms, thighs, buttocks, shoulders
3Risk Factors for Lipodystrophy (LD) Non-modifiableIncreasing ageFemale genderGreater duration of ARVGreater body weight before ARVModifiableSmokingDiet: Smaller intake of total protein and total dietary fiber while taking ARVHendricks et al 2003 Am Journal Clinical Nutrition, case control study of 47 cases
4Study 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 oilmoderate intake of fishlow to moderate intake of dairy productslow intake of meat and poultrymoderate intake of alcoholPopulation-based Greek study found Mediterranean diet protective against death due to coronary heart disease and cancer.Population based (22,043 participants) prospective study of this diet in the Greek population was published in 2003 Found that a higher degree of adherence to the diet was associated with a reduction in total mortality, inverse association between diet adherence and death due to coronary heart disease and death due to cancer
5Croatia: 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 dietsApproximately 450 people identified as having HIV in Croatia
6Methods136 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.Severity and number of signs was used to categorize patients as having lipoatrophy and/or lipohypertrophyMetabolic characteristics included HDL, LDL and total cholesterol. Body measurements included waist-to-hip ratio, change in BMI, weight prior to HAART
7Measuring 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 fish3 Detrimental categories: meat, poultry, dairyModerate alcohol consumption considered beneficialA ten-point adherence scale dichotomized into:< 4 points = low adherence 4 points = medium and high adherenceSex-specific median cutoffs
8Results 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.
9Risk Factors for LD 56 with lipoatrophy, 44 with lipohypertrophy, 56 with lipoatrophy, 44 with lipohypertrophy,Stavudine is a Nucleotide reverse transcriptase inhibitor
10LD and Food CategoriesMen 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).MeatFishVegetable OilsDietary intake from 108 men in relation to lipodystrophy
11Discussion: 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.
12ConclusionsDietAdherence 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.SmokingFormer or current smokers had higher risk of lipoatrophy (p=0.042)
13Study Limitations Cross-sectional design Prospective randomization not possibleDifficult to infer causality due to multiple confoundersResults specific to this patient group and may not be generalizable;One time point for assessment of lipodystrophyQuestionable accuracy of retrospective dietary information;LD determined by self-report and physical exam.
14Plitvice Lakes National Park , Croatia Dr. Josip Begovac, Christine Stanley, Sarah Gertler, Nancy Gertler