Abstract Book Vol. 2 [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

144 Abstracts WePeC6257-WePeC6261

XIV International AIDS Conference

WePeC6257 A new proposal to deal with facial lipodistrophy
V. Vasques, M. Garcia, E. Cortes. Hospital da Lagoa, Rua Mario Portela,
161/C/804, Rio de Janeiro, RJ, 22241-000, Brazil
Background: The highly active antiretroviral therapy (HAART) is effective, but
lipodistrophy (LD), mainly from face, is an adverse event that interferes with the
self-steem and the adherence to treatment. As there is no treatment available for
that condition, we study a muscular facial hypertrophy to fill the space left from
the fat wasting.
Methods: We accompanied 6 male patients, with age ranging from 34 to 57
years, 2 with mild, 2 with moderate and 2 with severe LD. Their time on antiretroviral therapy ranged from 2 to 7 years. The time of LD appearance was difficult
to ascertain. To study the improvement in LD, we made a protocol based on the
phonological evaluation of the subjects, that included suction, mastication, deglutition and respiration, besides to the bio-mechanical alignment of phonological
organs (lips, tongue, cheeks, mandibles, soft and hard palate and teeth). Each
patient had a picture taken on resting facial position and smiling, before and 3
months after starting treatment. We used the orofacial mio-functional therapy to
strength the facial muscles, working out cheeks, lips and tongue. The subjects
were followed once a week for the first month by the phonologist, doing the exercises for 30 minutes 3 times a day at home. They were then followed every 2
weeks.
Results: Two subjects with mild LD and 1 with severe LD had a great improvement. The other patient with severe LD was lost to follow-up. The two subjects
with moderate LD remained stable. The exercises led to hypertrophy of muscles involved in the facial expression and mastication, partially filling the facial fat
wasting. The willingness for improvement and the emotional status influenced the
outcome.
Conclusions: That kind of treatment can be used early in the care of patients on
HAART, acting as a preventive tool or delaying the onset of facial LD. A phonologist, to prevent asymmetries, chewing and oral occlusion problems, must orient
the patient. Pictures will be presented.
Presenting author: Virginia Vasques, Rua Mario Portela, 161/C/804, Rio de
Janeiro, RJ, 22241-000, Brazil, Tel.: [phone], Fax: [phone],
E-mail: [email protected]
WePeC6258 Impact of Highly Active Antiretroviral Therapy on
endothelial function of HIV-positive subjects
K. de Gaetano Donati1, M. Tumbarello1, E. Tacconelli1, R. Rabagliati1,
R. Cauda1, C. Amore2, L. lacoviello2. 1Catholic University, Dept. Infectious
Diseases, Catholic University Largo A. Gemelli, 8, 00168 Roma, Italy;
2Consorzio Mario Negri Sud, S. Maria Imbaro (Ch), Italy
Introduction: The introduction of Highly Active Antiretroviral Therapy (HAART) in
the treatment of HIV-infected subjects has reduced morbidity and mortality. However, HAART has been associated with peripheral fat wasting, central obesity,
hypertriglyceridemia, and glucose intolerance. It is unknown if these metabolic
abnormalities are associated with increased risk of atherosclerosis. Aims of the
study are: 1) To define whether HIV virus or HIV-related opportunistic infections
induces any endothelial damage; 2) To verify the impact, if any, of HAART on this
damage.
Methods: We performed a prospective study including consecutive HIV positive
subjects admitted to the Department of Infectious Diseases of the Catholic University, in Rome. We included 60 naive subjects and 60 HAART treated patients
[with 2 nucleoside analogues plus either 1 protease inhibitor, PI1(30) or 1 non
nucleoside analogue, NNRT (30)]. Active intravenous drug abusers and subjects
with familial dyslipidemic disorders were excluded from the study. Markers of endothelial injury (t-PA, PAl-i, P-selectin, ICAM) as well as other blood parameters
of cardiovascular risk (fibrinogen, C reactive protein, HDL and LDL cholesterol,
triglycerides, microalbuminuria) were evaluated. The two groups were comparable for age, sex and conventional risk factors for cardiovascular disease.
Results: are shown in the table (ng/ml)
PAl-1 t-PA P-selectin ICAM
Naive 28.3 ~ 25 6.8 ~ 4.1 115 ~ 55 572 ~ 166
HAART 40.9 ~ 29* 9.7 -4.8** 144 ~ 72* 528 ~ 240
PI 38.7 - 21 10.7 + 5.8 154 ~ 83 557 ~ 280
NNRT 43.1 - 38 8.6 + 3.3 134 + 57 496 ~ 189
*P <0.01; **P <0.001
No statistically significant difference was found comparing markers of endothelial
injury between subjects treated with PI or with NNRT.
Conclusions: These data indicate an increased endothelial activation in HAARTtreated versus untreated HIV patients, that might predispose to thrombotic complications.
Presenting author: Katleen de Gaetano Donati, Dept. Infectious Diseases,
Catholic University, Largo A. Gemelli, 8, 00168 Roma, Italy, Tel.: +39-06 -
30155373, Fax: [phone], E-mail: [email protected]

WePeC6259I Nevirapine (NVP) related toxicity after long term
Emivirine (EMV) treatment
F.M. Conradie, RD. Ive, W.D.F. Venter, I.M. Sanne. University of the
Witwatersrand, Postnet Suite 176, Private Bag X2600, Houghton, 2041, South
Africa
Background: NVP is a non-nucleoside reverse transcriptase inhibitor (NNRTI)
registered for the treatment of HIV infection. It is associated with hepatoxicity
(17% with grade3-4 AST or ALT) and serious skin reactions (17% for skin reactions with a 7% discontinuation rate). There is little data on the safety of swapping
to NVP once a patient is stabilized on treatment in a NNRTI containing regimen.
Methods: In this retrospective, descriptive record review of 13 patients on a
rollover protocol after an investigational NNRTI, EMV, we observed high levels
of both adverse reactions.
The patients were on a triple drug regimen consisting of two nucleosides, ddl and
D4T with EMV for 104-115 weeks. At the end of the trial, the patients with an undetectable viral load were granted a post protocol regimen of Combivir and NVPR
The patients had a two-week lead-in dose of NVP.
Results: 8/13 of the patients discontinued the NVP containing regimen. 6/13 of
patients developed grade 3-4 AST, ALT or GGT. 5/13 patients developed skin reactions. Two of the patients were discontinued for grade 3-4 rash alone. Of the
3 patients who developed both hepatotoxicity and rash, one was admitted with
a Steven Johnson Syndrome. A further patient required admission for vomiting
associated with Grade 4 AST, ALT and GGT
These events in these patients resolved completely. An alternative regimen of
Combivir and Nelfinavir offered to these patients was well tolerated in 8/8 patients
without further adverse events.
Conclusions: Although the numbers are small, the discontinuation rate of 62%
is higher than other reported studies A possible etiology is that EMV is an inducer
of CYP450. EMV may induce the metabolism of NVP in a manner other than the
induction of NVP metabolism by NVP itself. Giving NVP after the use of other
NNRTI's needs to be further investigated.
Presenting author: Francesca Conradie, Postnet Suite 176, Private Bag X2600,
Houghton, 2041, South Africa, Tel.: [phone], Fax: [phone], E-mail: francescaconradie @ witshealth.co.za
WePeC6260 The D:A:D (Data Collection on Adverse Events of
Anti-HIV Drugs) Study: Modelling risk of
cardiovascular events in HIV
Background: Antiretroviral therapy (ARV) can induce metabolic adverse effects,
possibly leading to an accelerated atherosclerotic process. However, no data exist to suggest that risk factor profiles induced by ARV drugs mimic the risk profile
for cardiovascular disease in the background population.
Methods: Baseline risk factors for the development of CVD were collected on
17.852 HIV-patients from Europe, USA and Australia, enrolled in DAD, a prospective cohort study assessing risk of CVD, established in year 2000. Here, individual
patient baseline variables were used to predict risk of myocardial infarction (MI)
based on the Framingham score. Three scenarios were examined: The observed
metabolic alterations: a) immediately lead to an increased risk of CVD, b) does
not affect risk of CVD, or c) features of the metabolic syndrome (lipodystrophy,
obesity and/or elevated triglycerides - similar to syndrome X), equals the importance of diabetes in the Framingham score. Risk of MI was summarised following
stratification of subjects in six groups according to ARV at baseline (table).
Results: The number of MI in the DAD study over a three year follow up period
was estimated to be 131, 64 and 205 cases under scenarios a, b and c, resp.
(table). The incidence was estimated to increase from 0,3% in naive patients to
1,1% in patients receiving PI/NNRTI (scenario a). Few (<10) events were predicted among the 4,290 women in the study.
Conclusions: The results are preliminary estimates of risk of MI, which will be
compared with the observed incidence rates in D:A:D (available in 4Q of 2002).
The estimates should be interpreted with extreme caution until observed data
become available as the applied algorithms have not been validated for an HIVinfected population.
Presenting author: Nina Friis-Meller, CHIP, Dep. Infectious Dis. 144, Hvidovre
Hospital, 2650 Copenhagen, Denmark, Tel.: [phone], Fax: [phone]
40, E-mail: [email protected]
WePeC6261 Development of and risk factors for lipoatrophy
(abnormal fat loss) in ambulatory hiv-1 infected
patients
K.A. Lichtenstein1, K.M. Delaney2, D.J. Ward3, A.C. Moorman2,
S.D. Holmberg2, K.C. Wood4. 1Rose Medical Center, 4545 east 9th avenue,
suite 120, denver, colorado, 80220, United States; 2Centers for Disease Control,
Atlanta, United States; 3Dupont Circle Physicians, Washington DC, United
States; 4Cerner Corporation, McLean, United States

Background: The factors contributing to the development of HIV-associated
lipodystrophy are still unclear. This study identifies the clinical factors associated
with the incidence of lipoatrophy (abnormal fat lost), one of the manifestations of
the lipodystrophy syndrome.
Methods: This is a prospective analysis of HIV-1 infected patients in the HIV Outpatient Study (HOPS) evaluated for clinical signs of lipoatrophy at two visits about