See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/8550810 Lipoatrophy Is the Predominant Presentation of HIV-Associated Lipodystrophy in Southern India Article in Clinical Infectious Diseases · July 2004 DOI: 10.1086/392516 · Source: PubMed CITATIONS READS 14 57 6 authors , including: Sreekanth K Chaguturu N Kumarasamy Massachusetts General Hospital Voluntary Health Services Multi-Specialty Hospital and Research Institute 23 PUBLICATIONS 749 CITATIONS 571 PUBLICATIONS 15,673 CITATIONS SEE PROFILE SEE PROFILE Suniti Solomon Kenneth Mayer YR Gaitonde Centre for AIDS Research and Education Beth Israel Deaconess Medical Center 345 PUBLICATIONS 8,396 CITATIONS 1,118 PUBLICATIONS 51,792 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Punto Seguro: Conditional Economic Incentives to Reduce HIV/STI Risks among Male Sex Workers in Mexico City View project Gradients in Depressive Symptoms by Socioeconomic Position Among Men Who Have Sex With Men in the EXPLORE Study View project All content following this page was uploaded by Kenneth Mayer on 22 May 2014. The user has requested enhancement of the downloaded file.
Lipoatrophy Is the ments were obtained in triplicate by 1 septic arthritis in patients with hepatic cir- Predominant Presentation rhosis, especially in those with pneumo- trained observer, and the data presented of HIV-Associated coccal primary peritonitis. is the mean of the 3 measurements. Bio- Lipodystrophy electric impedance analysis was performed in Southern India J. Mun ˜oz, R. Paredes, I. Diaz, I. Basabe, with the Quantum II analyzer (RJL Sys- Sir —Because of the declining costs of an- V. Pomar, M. Blazquez, J. M. Guardiola, tems) while the patient was recumbent. M. Gurguı ´, and P. Domingo tiretroviral drugs and the production of Body composition was calculated with Infectious diseases Unit, Department of Internal drugs by generic manufacturers, tertiary Body Composition Analysis software, ver- Medicine, Hospital de la Santa Creu i Sant Pau, care centers in resource-limited areas are Barcelona, Spain sion 1.2 (Cyprus). CD4 lymphocyte now able to provide antiretroviral therapy counts were performed by flow cytometry to HIV-seropositive patients [1]. However, (Becton Dickinson). despite the unprecedented benefits of Five of the patients were male. The av- HAART, there appear to be metabolic and erage age of the 8 patients was 41 years, morphologic complications associated References whereas the mean age of patients seen at with therapy. These long-term adverse ef- this clinic is 32 years. The 8 patients re- 1. Ross JJ, Saltzman CL, Carling P, et al. Pneu- fects have been described primarily in the mococcal septic arthritis: review of 190 cases. ceived antiretroviral therapy for anaverage Western world, where use of antiretroviral Clin Infect Dis 2003 ;36:319–27. of 46 months. The mean increase in CD4 therapy is more widespread. 2. Capdevila O, Pallares R, Grau I, et al. Pneu- cell counts for this cohort was 268 cells/ mococcal peritonitis in adult patients: report At YRG CARE, a nonprofit organiza- m L in 4 months, whereas the mean in- of 64 cases with special reference to emergence tion and tertiary referral care center in of antibiotic resistance. Arch Intern Med crease for all patients receiving antiretro- southern India that provides medical and 2001 ;161:1742–8. viral therapy at this clinic ( n p 286 ) is 159 psychosocial care for nearly 4000 people 3. Dugi DD, Musher DM, Clarridge JE, et al. cells/ m L in 4 months. The 8 patients had Intraabdominal infection due to Streptococcus living with HIV infection, all patients re- a median difference of 6 kg/m 2 (range, 2.9 pneumoniae. Medicine 2001 ;80:236–44. ceiving antiretroviral therapy (ART) have 4. Marin E, Navas C, Martin-Vivaldi J, et al. Sep- kg/m 2 –14.2 kg/m 2 ) between their highest had anthropometric measurements taken tic arthritis due to Streptococcus bovis in a pa- and lowest BMI values. Every patient sub- at each clinic visit, starting in January tient with cirrhosis of enolic etiology. Rev Esp jectively noticed atrophy. Five patients Enferm Dig 2003 ;95:506–8. 2002. Among 286 patients receiving ART, 5. Malnick SD, Attali M, Israeli E, et al. Spon- complained of loss of limb fat, 4 noted we have identified 8 patients who devel- taneous bacterial artrhitis in a cirrhotic pa- changes in their thighs, and 2 noted oped lipoatrophy (6 with buccal atrophy tient. J Clin Gastroenterol 1998 ;27:364–6. changes in their arms. Their self-assess- and 5 with limb fat atrophy) while re- 6. Rosas J, Casellas JA, Carnicer F, Batlle E. Septic ments were confirmed by observations arthritis caused by Streptococcus agalactiae in ceiving ART (table 1). a patient with liver cirrhosis [in Spanish].Med Weight and height measurements were made by a primary care provider, who Clin (Barc) 1991 ;97:755. obtained with a standardized scale. Body noted buccal atrophy in 6 and limb fat 7. Colebunders R, Cytryn E, Thys JP. Group B mass index was calculated as weight in atrophy in 5. streptoccocus arthritis. Clin Rheumatol 1983 ;2:427–9. kilograms divided by the square of height Four patients developed morphologic 8. Pearson RD, Spiva D, Gluckman J. Cirrhosis in centimeters. Anthropometric measure- changes while receiving 2-drug therapy, of liver with septic arthritis due to Escherichia coli: unusual locus minoris resistenciae for bacteremic cirrhosis. N Y State J Med 1978 ; Table 1. Clinical characteristics of 8 south Indian patients who de- 78:1762–3. veloped lipoatrophy while receiving antiretroviral therapy (ART). 9. Schlaeffer F, Riesenberg K, Mikolich D,Sikuler E, Niv Y. Serious bacterial infections after en- Mean no. doscopic procedures. Arch Intern Med 1996 ; Patient group, variable of months 156:572–4. Patients receiving ART ( n p 8) 10. Mang G, Walter E, Bertschinger P, et al. Bac- terial infections following sclerosing therapy Time receiving ART 46 for esophaeal varices [in German]. Schweiz Time to morphologic change while receiving ART 21 Med Wochenschr 1993 ;123:1796–801. Patients receiving HAART ( n p 5 a ) Time receiving HAART 24 Reprints or correspondence: Dr. Jose Mun ˜oz, Infectious Dis- Time to morphologic change while receiving HAART 20 eases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret, 167, Patients receiving 2-drug therapy ( n p 4) 08025 Barcelona, Spain (meth_2@hotmail.com). Time receiving 2-drug therapy 44 Clinical Infectious Diseases 2004;38:1645–6 Time to morphologic change while receiving 2-drug therapy 22 � 2004 by the Infectious Diseases Society of America. All a One patient received both dual nucleoside therapy and HAART rights reserved. 1058-4838/2004/3811-0030$15.00 . 1646 • CID 2004:38 (1 June) • CORRESPONDENCE
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