Journal Article

Association between <i>HLA-B*4001</i> and Lipodystrophy among HIV-Infected Patients from Thailand Who Received a Stavudine-Containing Antiretroviral Regimen

Wittaya Wangsomboonsiri, Surakameth Mahasirimongkol, Soranun Chantarangsu, Sasisopin Kiertiburanakul, Angkana Charoenyingwattana, Surat Komindr, Chupong Thongnak, Taisei Mushiroda, Yusuke Nakamura, Wasun Chantratita and Somnuek Sungkanuparph

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 4, pages 597-604
Published in print February 2010 | ISSN: 1058-4838
Published online February 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/650003
Association between HLA-B*4001 and Lipodystrophy among HIV-Infected Patients from Thailand Who Received a Stavudine-Containing Antiretroviral Regimen

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Background. Stavudine-containing antiretroviral regimens are widely used in developing countries. Stavudine-associated lipodystrophy commonly occurs, without a clear predictable pattern owing to the unknown interaction between stavudine and the host, among patients who received this regimen. The aim of this study was to determine the clinical risk factors and human leukocyte antigen (HLA) alleles associated with stavudine-associated lipodystrophy.

Methods. A case-control, cross-sectional study was conducted for HIV-infected patients receiving stavudine-containing antiretroviral regimens. Clinical assessments for lipodystrophy by physical examination, anthropometry, and dual-energy X-ray absorptiometry were obtained. On the basis of their clinical assessment, the patients were classified into 2 groups: the case group (moderated to severe lipodystrophy) and the control group (absent to mild lipodystrophy). The clinical characteristics and allelic distribution of HLA-A, HLA-B, HLA-C, HLA-DRB1, HLA-DQB1, and HLA-DPB1 were compared between the case group and the control group, to determine the possible association with stavudine-associated lipodystrophy.

Results. There were 103 patients; 55 patients were in the case group, and 48 patients were in the control group. By use of forward stepwise logistic regression, the presence of HLA-B*4001 (odds ratio [OR], 14.05; 95% confidence interval [CI], 2.57–76.59; P=.002) and a longer duration of stavudine treatment (OR, 1.02; 95% CI, 1.00–1.04; P=.02) were significantly associated with stavudine-associated lipodystrophy, whereas a higher body mass index during treatment (OR, 0.73; 95% CI, 0.61–0.86; P<.001) was associated with a lower risk for lipodystrophy. HLA-B*4001 has a high specificity (95.8%) and a positive predictive value (88.9%) for lipodystrophy.

Conclusions. HLA-B*4001 is a strong genetic risk factor for stavudine-associated lipodystrophy in HIV-infected patients in Thailand. HLA-B*4001 may be used as a genetic marker to predict which patients will develop stavudine-associated lipodystrophy, to avoid or shorten the duration of stavudine use. This finding needs to be confirmed in further replication studies.

Journal Article.  4435 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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