Metabolic factors associated with the development of lipodystrophy in patients on long-term highly active anti-retroviral therapy (HAART)

Dyslipidemia, insulin resistance and diabetes are frequent in patients on highly active anti-retroviral therapy (HAART) and especially in patients with lipodystrophy, and may lead to atherosclerosis. This study described the metabolic alterations associated with lipodystrophy in adults on chronic HAART in Kenya. The prevalence of dyslipidaemia amongst the study participants was (211) 79.6%. Elevated total cholesterol was found in 129, high low-density-lipoprotein cholesterol (LDL-C) in 107, low High-density lipoprotein cholesterol (HDL-C) in 110 and high triglycerides in 131 participants. Lipodystrophic patients were more likely to have dyslipidemia than normal lipids (55.4 versus 35.1%, p = 0.007 OR 2.2 CI 1.3 to 4.6) with 57, 45.9, 65.9 and 45.2% having elevated total cholesterol, elevated LDL-C, elevated triglycerides and low HDL-C, respectively. Hypertriglyceridemia and hypercholesterolemia were significantly associated with lipodystrophy (OR 3.8 CI 2.3 to 6.4; p = 0.000) and (OR 1.94 CI 1.2 to 3.2; p = 0.008), respectively. The odds of lipodystrophy was 2.913 times higher for patients with elevated triglycerides than for those with normal triglycerides (p < 0.001). Sixty-four (24.3%) participants had dysglycemia, with 3.5% having diabetes and 20.8% having impaired fasting glucose (IFG). Among patient with lipodystrophy, 69.8% had normal fasting glucose, 25.1% had IFG and 5.1% were diabetic. Lipodystrophic patients were not more likely to have abnormal blood sugars than normal blood sugars (p value 0.125).