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

• Published in: AIDS (London) Vol. 18; no. 7; pp. 1029 - 1036
• Main Authors: Martin, Allison, Smith, Don E, Carr, Andrew, Ringland, Clare, Amin, Janaki, Emery, Sean, Hoy, Jennifer, Workman, Cassy, Doong, Nicholas, Freund, Judith, Cooper, David A
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 30.04.2004
• Subjects: Absorptiometry, Photon; Adipose Tissue - pathology; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Biological and medical sciences; Body Composition - drug effects; Bone Density - drug effects; Dermatology; Dideoxynucleosides - therapeutic use; Follow-Up Studies; HIV Infections - drug therapy; HIV-Associated Lipodystrophy Syndrome - chemically induced; HIV-Associated Lipodystrophy Syndrome - pathology; Human viral diseases; Humans; Infectious diseases; Medical sciences; Reverse Transcriptase Inhibitors - adverse effects; Reverse Transcriptase Inhibitors - therapeutic use; Skin involvement in other diseases. Miscellaneous. General aspects; Stavudine - adverse effects; Stavudine - therapeutic use; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Zidovudine - adverse effects; Zidovudine - therapeutic use; Australia; Oceania; Skin disease; Purine nucleoside; RNA-directed DNA polymerase; Prognosis; Check; Thymidine; Stavudine; Fat mass; thymidine analogues; Prevention; Design; Reverse transcriptase inhibitor; Limb; Antiviral; Ambulatory; Pyrimidine nucleoside; HIV lipodystrophy; Human; Immunopathology; Enzyme; Critically ill; Subcutaneous; Transferases; Enzyme inhibitor; Retroviridae; Definition; AIDS; Immune deficiency; Lentivirus; Long term; Infection; Virus; Nucleotidyltransferases; Chemotherapy; Lipoatrophy; Dideoxynucleoside; Viral disease; Abacavir; Lipodystrophy; Reversibility; Nucleosidic analog; Adipose tissue disorders; Human immunodeficiency virus; Arm; Zidovudine
• ISSN: 0269-9370
• DOI: 10.1097/00002030-200404300-00011

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). Long-term follow-up (104 weeks) of a randomized, open-label study. Seventeen ambulatory HIV clinics in Australia and London. 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). 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. The primary endpoint was time-weighted change in limb fat mass, measured by dual-energy X-ray absorptiometry (DEXA). 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. 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.