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Prevalence of lipodystrophy after 3 years of WHO first line ART and its impact on quality of life and negative perception to ART in Thailand
Presented by Suwat Chariyalertsak, Thailand.
S. Chariyalertsak1, P. Oberdopher2, J. Suwanteerangkul3, D. Thapinta4, A. Wu5
1Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand, 2Faculty of Medicine, Chiang Mai University, Paediatric, Chiang Mai, Thailand, 3Faculty of Medicine, Chiang Mai University, Community Medicine, Chiang Mai, Thailand, 4Faculty of Nursing, Chiang Mai University, Psychiatry, Chiang Mai, Thailand, 5Johns Hopkins Bloomberg School of Public Health, Health Policy and Management, Baltimore, United States
Background: The WHO guidelines recommend ART including stavudine(d4T) as first line regimens in resource-limited countries. However, these have been linked with high risk of lipodystrophy. Although Thailand have been successfully in scaling up for ART, but little is known about prevalence of lipodystrophy and its impact on quality of life and negative perception to ART in long term follow-up.
Methods: HIV-infected patients who treated with first line ART regimens from 45 community hospitals in Northern Thailand were enrolled in a cohort study. Information collected included ART regimens, quality of life assessment using SF12 questionnaire. Lipodystrophy was self-report diagnosed. Perception of lipodystrophy to ART was interviewed for those who faced this syndrome.
Results: Between April 2004 and October 2004, 753 naïve HIV-infected patients were enrolled and were followed up for 3 years. One hundred and one patients (13.4%) have died. There were 559 patients who remained on the study at 36-month follow-up be interviewed. Mean age was 35.8 years, and 53.7% were female. At enrollment, 98.9% were on d4T/lamivudine [3TC]/nevirapine [NVP], and 1.1% on d4T/lamivudine [3TC]/efavirenz [EFV]. At 36th month, 73.7% were still on d4T/3TC/NVP and 6.4% on d4T/3TC/EFV. Eighteen percents of patients had replaced d4T with zidovudine (AZT) due to lipodystrophy. Prevalence of lipodystrophy was 27.7%. The most common sites of lipodystrophy were at cheek (20.0%). Quality of life (both physical and mental health) between lipodystrophy patients and non-lipodystrophy patients showed statistically significant (p<0.05). Being female and older age were associated with lipodystrophy. Perception to ART among those who developed lipodystrophy, 14.8% feel very strong desirable to change ART, 13.5% feel very nervous about their body image change, and 5.1% feel want to stop ART drug.
Conclusions: Therapeutic and preventive strategies such as NRTI switch and adjustment of first line ART need to be reassessed urgently to reduce impact of this syndrome on adherence and social stigmatization.
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