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Johan van Griensven 1 , Vichet Phan 2 , Sopheak Thai 2 , Olivier Koole 1 , Lutgarde Lynen 1

THPDB103. Eight out of ten adults on stavudine-based antiretroviral treatment develop treatment limiting lipodystrophy by six years of treatment in Cambodia. Johan van Griensven 1 , Vichet Phan 2 , Sopheak Thai 2 , Olivier Koole 1 , Lutgarde Lynen 1

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Johan van Griensven 1 , Vichet Phan 2 , Sopheak Thai 2 , Olivier Koole 1 , Lutgarde Lynen 1

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  1. THPDB103 Eight out of ten adults on stavudine-based antiretroviral treatment develop treatment limiting lipodystrophy by six years of treatment in Cambodia Johan van Griensven1, Vichet Phan2, Sopheak Thai2, Olivier Koole 1, Lutgarde Lynen 1 1Institute of Tropical Medicine, Antwerp, Belgium 2Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia

  2. Background: - Majority of patients on ART in LMIC still take stavudine(d4T)-containing regimens - Long-term toxicity in LMIC remains poorly described. • Methods: - ART program data from Sihanouk-Hospital-Center-of-Hope, Phnom Penh, Cambodia, launched March 2003. - Standardized screening for side-effects • Clinical diagnosis of lipodystrophy • Low threshold for d4T substitution - All adult patients initiating d4T-based HAART included in the analysis - Probabilities of "time to first treatment-limiting toxicity" related to d4T - Multivariate Cox regression modeling

  3. Results: Risk factors neuropathy Older age (HR 1.53/10 years;95%CI: 1.33-1.76). Higher baseline CD4 counts (HR 0.82/100 cells/µL;95%CI: 0.70-0.95). Higher baseline body weight (HR 0.82; 95%CI: 0.70-0.95). Weight increase in the first six months (HR 0.73/5 kg;95%CI: 0.54-0.98). Risk factors for lactic acidosis Being on TB treatment at ART initiation (HR 5.39;95%CI: 1.66-17.49). A higher baseline body mass index (HR 1.18/kg/m2;95%CI: 1.06-1.32). Risk factors for lipodystrophy Female gender (HR 2.54;95%CI: 2.18-2.95). ART initiation with efavirenz (HR 1.32;95%CI: 1.12-1.57). Older age (HR 1.14/10 years;95%CI: 1.04-1.21). 4

  4. LIMITATIONS Retrospective analysis of program data No validated case definitions CONCLUSION Significant long-term toxicities with d4T Lipodystrophy: major long-term side-effect Phasing out of stavudine ! Limitations & conclusion Acknowledgements: We are grateful to all staff of Infectious diseases department, Sihanouk Hospital, Center of HOPE, Phnom Penh, Cambodia, and to the Institute Tropical Medicine, Antwerp, Belgium and the Belgian DGDC for funding the data collection (project 920800). Email:vichetphan@sihosp.org

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