The aim of this study was to determine the patterns of change in body fat and metabolic parameters in a South
African cohort on a first line ART regimen containing stavudine. Fasting lipogram, blood glucose and insulin
levels, CD4 cell count, viral load, BMI, waist-to-hip ratio (WHR), and skinfold thickness at the triceps, scapula,
and iliac crest were measured before starting ART in 42 (27 female) subjects. Repeat measurements were
performed at four monthly intervals for 2 years. Lipodystrophy was diagnosed using patient perception and
assessment by a physician. At baseline, subjects who went on to develop lipodystrophy (LD group) were fatter
and had higher skinfold thickness at all three sites and higher insulin levels than subjects who never developed
lipodystrophy (NLD group). The WHR increased to a greater extent while hip circumference and tricep skinfolds
fell more significantly in the LD than NLD group. Triglyceride and cholesterol levels increased significantly in
both groups while lactate and glucose levels increased more and insulin levels increased less in the LD than the
NLD group. Neither viral load nor CD4 count differed between the groups during the study. Viral load correlated
positively with insulin levels at baseline. Thus, lipodystrophy in the South African population is characterized
by a higher BMI before initiation of ART and lipoatrophy of the arms and hips, lipohypertrophy of the
waist, and increased lactate production. When compared to the NLD group, the LD subjects display attenuated
insulin secretory output in response to a higher weight gain.
