Reduced dose of stavudine and lipoatrophy in HIV-infected patients in Cameroon.

Background: This study assessed the effect of stavudine (d4T) 30 mg dosage on lipoatrophy in HIV-infected patients on antiretroviral treatment. Methods: A total of 243 patients from Cameroon receiving d4T or zidovudine (AZT) in combination with lamivudine and efavirenz or nevirapine for >6 months were clinically assessed for moderate to severe ('strict' definition) and mild to severe ('large' definition) lipoatrophy. Prevalence of lipoatrophy was compared between 69 patients who had received exclusively d4T 30 mg (d4T 30 ), 64 patients who had received both d4T 30 and 40 mg dosages since treatment initiation (d4T 30/40 ) and 110 patients on AZT-related therapy. Results: Prevalence of lipoatrophy varied from 7% to 24%, according to the definition. After adjustment for gender, age, treatment duration and CD4 + T-cell count, the risk of lipoatrophy in the d4T 30 group was lower than in the d4T 30/40 group (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.8 with the large definition and OR 0.2, 95% CI 0.0-0.8 with the strict definition) and was comparable to that of the AZT group (OR 1.0, 95% CI 0.2-4.6 and OR 1.0, 95% CI 0.4-2.2 with the large and strict definitions, respectively). The risk was significantly higher in the d4T 30/40 group compared with the AZT group (OR 2.9, 95% CI 1.3-6.4 with the large definition and OR 5.5, 95% CI 1.3-23.5 with the strict definition). Conclusions: The use of d4T at a lower dosage might increase safety with regard to its effect on lipoatrophy.