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Title: Association between HLA-B*4001 and lipodystrophy among HIV-infected patients from Thailand who received a stavudine-containing antiretroviral regimen
Authors: Wittaya Wangsomboonsiri
Surakameth Mahasirimongkol
Soranun Chantarangsu
Sasisopin Kiertiburanakul
Angkana Charoenyingwattana
Surat Komindr
Chupong Thongnak
Taisei Mushiroda
Yusuke Nakamura
Wasun Chantratita
Somnuek Sungkanuparph
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Mahidol University
Thailand Ministry of Public Health
Institute of Medical Science The University of Tokyo
Keywords: Medicine
Issue Date: 15-Feb-2010
Citation: Clinical Infectious Diseases. Vol.50, No.4 (2010), 597-604
Abstract: Background. Stavudine-containing antiretroviral regimens are widely used in developing countries. Stavudineassociated 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 stavudinecontaining 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 stavudineassociated lipodystrophy, to avoid or shorten the duration of stavudine use. This finding needs to be confirmed in further replication studies. © 2010 by the Infectious Diseases Society of America. All rights reserved.
ISSN: 10584838
Appears in Collections:Scopus 2006-2010

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