Improvement in Lipoatrophy Associated with Highly Active Antiretroviral Therapy in Human Immunodeficiency Virus—Infected Patients Switched from Stavudine to Abacavir or Zidovudine: The Results of the TARHEEL Study

• Published in: Clinical infectious diseases Vol. 38; no. 2; pp. 263 - 270
• Main Authors: McComsey, Grace A., Ward, Douglas J., Hessenthaler, Siegrid M., Sension, Michael G., Shalit, Peter, Lonergan, J. Tyler, Fisher, Robin L., Williams, Vanessa C., Hernandez, Jaime E.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15.01.2004; University of Chicago Press
• Subjects: Abdominal fat; Adult; AIDS; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active; Antiretrovirals; Biological and medical sciences; Body fat; Dermatology; Dideoxynucleosides - adverse effects; Dideoxynucleosides - therapeutic use; Fats; Female; Highly active antiretroviral therapy; HIV; HIV 1; HIV Infections - drug therapy; HIV Infections - virology; HIV-1 - genetics; HIV-1 - physiology; HIV/AIDS; Human viral diseases; Humans; Infectious diseases; Lactates; Lipodystrophy; Lipodystrophy - chemically induced; Male; Medical sciences; Middle Aged; RNA; RNA, Viral; Skin involvement in other diseases. Miscellaneous. General aspects; Stavudine - adverse effects; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral Load; Zidovudine - adverse effects; Zidovudine - therapeutic use; Skin disease; Purine nucleoside; RNA-directed DNA polymerase; Questionnaire; Body image; Stavudine; Microbiological investigation; Reverse transcriptase inhibitor; Antiviral; Complication; Face; Pyrimidine nucleoside; Viral load; Buttock; Human; Immunopathology; Enzyme; Transferases; Use; Enzyme inhibitor; Retroviridae; AIDS; Immune deficiency; Lentivirus; Leg; Infection; Virus; Case study; Nucleotidyltransferases; Chemotherapy; Treatment; Lipoatrophy; Dideoxynucleoside; Viral disease; Abacavir; Nucleosidic analog; Adipose tissue disorders; Human immunodeficiency virus; Arm; Zidovudine; Comparative study
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1086/380790

Stavudine use is a contributing factor for lipoatrophy, whereas use of abacavir or zidovudine is less likely to cause this complication. The TARHEEL study was a 48-week, open-label study that assessed changes in lipoatrophy after abacavir (86 patients [73%]) or zidovudine (32 patients [27%]), 300 mg twice daily, was substituted for stavudine for 118 human immunodeficiency virus (HIV)–infected patients (HIV type 1 RNA level, <400 copies/mL) with virological suppression who had developed lipoatrophy after ⩾6 months of stavudine-based treatment. At week 48, full-body dual-energy x-ray absorptiometry demonstrated a median increase in arm fat of 35%, leg fat of 12%, and trunk fat of 18%, compared with the baseline level. These improvements coincided with fat gain in lipoatrophic areas that was documented by computerized tomography. Results of a “body image” questionnaire showed that a substantial percentage of patients reported some or a lot of fat gain in the arms (22%), legs (18%), buttocks (19%), and face (27%). HIV suppression was maintained over the study period. In conclusion, replacing stavudine with abacavir or zidovudine resulted in improvement in stavudine-induced lipoatrophy.