Reversibility of lipoatrophy in HIV-infected patients 2 years after switching from a thymidine analogue to abacavir: the MITOX Extension Study.

Abstract

OBJECTIVE:

To determine if long-term improvement in HIV lipoatrophy can be attained by substitution of thymidine analogues zidovudine (ZDV) or stavudine (d4T) with abacavir (ABC).

DESIGN:

Long-term follow-up (104 weeks) of a randomized, open-label study.

SETTING:

Seventeen ambulatory HIV clinics in Australia and London.

SUBJECTS:

Patients with HIV lipodystrophy were randomized to switch from a thymidine analogue to ABC, while continuing all other antiretroviral therapy (ABC arm) (n = 42) or continue current therapy (ZDV/d4T arm) (n = 43).

INTERVENTION:

At week 24, all control patients could switch to ABC. Of the original 111 patients randomized, 85 had long-term follow-up data, with 77 having imaging data available at 104 weeks.

MAIN OUTCOME MEASURE:

The primary endpoint was time-weighted change in limb fat mass, measured by dual-energy X-ray absorptiometry (DEXA).

RESULTS:

At week 104, the mean increase in limb fat for the ABC and ZDV/d4T group was 1.26 +/- 2.02 kg and 0.49 +/- 1.38 kg, respectively. The time-weighted change for limb fat was significantly different between the two arms (0.43 kg; P = 0.008). On-treatment analysis demonstrated a trend for increased limb fat in patients in the ABC arm. Visceral fat accumulation, buffalo hump, self-assessed lipodystrophy or the lipodystrophy case definition score (LCDS) did not improve.

CONCLUSIONS:

In patients with moderate-to-severe lipodystrophy, significant improvements in subcutaneous fat continued over 104 weeks after switching from a thymidine analogue to ABC. Nevertheless, the lipodystrophy syndrome was still evident, indicating additional strategies need evaluating.

• Authors: Allison Martin, Don E Smith, Andrew Carr, Clare Ringland, Janaki Amin, Sean Emery, Jennifer Hoy, Cassy Workman, Nicholas Doong, Judith Freund, David A Cooper, Mitochondrial Toxicity Study Group
• Journal: AIDS (London, England) (AIDS) Vol. 18 Issue 7 Pg. 1029-36 (Apr 30 2004) ISSN: 0269-9370 [Print] England
• PMID: 15096806 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-HIV Agents
• Dideoxynucleosides
• Reverse Transcriptase Inhibitors
• Zidovudine
• Stavudine
• abacavir

Topics

• Absorptiometry, Photon
• Adipose Tissue (pathology)
• Anti-HIV Agents (adverse effects, therapeutic use)
• Body Composition (drug effects)
• Bone Density (drug effects)
• Dideoxynucleosides (therapeutic use)
• Follow-Up Studies
• HIV Infections (drug therapy)
• HIV-Associated Lipodystrophy Syndrome (chemically induced, pathology)
• Humans
• Reverse Transcriptase Inhibitors (adverse effects, therapeutic use)
• Stavudine (adverse effects, therapeutic use)
• Zidovudine (adverse effects, therapeutic use)