Transactions of the Royal Society of Tropical Medicine and Hygiene 104 (2010) 751–757 Contents lists available at ScienceDirect Transactions of the Royal Society of Tropical Medicine and Hygiene journal homepage: http://www.elsevier.com/locate/trstmh Weight loss after the first year of stavudine-containing antiretroviral therapy and its association with lipoatrophy, virological failure, adherence and CD4 counts at primary health care level in Kigali, Rwanda Johan van Griensven a,b,∗ , Rony Zachariah a , Jules Mugabo c , Tony Reid a a Médecins Sans Frontières, Operational Centre Brussels, Medical Department, Duprestraat 94, 1090 Brussels, Belgium b Institute of Tropical Medicine, Nationalestraat 155, Antwerp, Belgium c Treatment and Research AIDS Centre, 2717 Kigali, Rwanda article info Article history: Received 28 February 2010 Received in revised form 27 August 2010 Accepted 27 August 2010 Keywords: weight loss antiretroviral treatment lipoatrophy Africa stavudine health center abstract This study was conducted among 609 adults on stavudine-based antiretroviral treatment (ART) for at least one year at health center level in Kigali, Rwanda to (a) determine the proportion who manifest weight loss after one year of ART (b) examine the association between such weight loss and a number of variables, namely: lipoatrophy, virological fail- ure, adherence and on-treatment CD4 count and (c) assess the validity and predictive values of weight loss to identify patients with lipoatrophy. Weight loss after the first year of ART was seen in 62% of all patients (median weight loss 3.1 kg/year). In multivariate analy- sis, weight loss was significantly associated with treatment-limiting lipoatrophy (adjusted effect/kg/year –2.0 kg, 95% confidence interval –0.6;-3.4 kg; P < 0.01). No significant associ- ation was found with virological failure or adherence. Higher on-treatment CD4 cell counts were protective against weight loss. Weight loss that was persistent, progressive and/or chronic was predictive of lipoatrophy, with a sensitivity and specificity of 72% and 77%, and positive and negative predictive values of 30% and 95%. In low-income countries, measur- ing weight is a routine clinical procedure that could be used to filter out individuals with lipoatrophy on stavudine-based ART, after alternative causes of weight loss have been ruled out. © 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. 1. Introduction Successful decentralization of antiretroviral treatment (ART) delivery is one of the key strategies required to achieve universal access to HIV care and treatment in low income countries (LIC). 1 Consequently, ART is increasingly being provided at lower levels of the health care sys- tem by less sophisticated and skilled medical staff. This ∗ Corresponding author. Tel.: +32 02474 7474; fax: +32 02474 7575. E-mail address: jvgrie@yahoo.com (J. van Griensven). requires easy-to-use, point-of-care, monitoring tools. 2,3 Unfortunately, such tools are not available as yet and care providers have to rely on the evolution of clinical markers to assess patients. Measurement of body weight is an easy-to-implement, routinely measured parame- ter used for the follow-up of patients on ART in LIC. A number of studies have reported on low baseline body weight or body mass index and its association with early mortality. 4–9 However, the determinants of weight evolution at later stages, particularly after the first year of ART, and its clin- ical significance remain poorly understood and there is 0035-9203/$ – see front matter © 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.trstmh.2010.08.016