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Date Posted: 18:40:28 07/24/02 Wed
Author: moonotter
Subject: Substituting Abacavir For Older NRTIs May Improve HIV-Related Lipoatrophy

Substituting Abacavir For Older NRTIs May Improve HIV-Related Lipoatrophy


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


By Megan Rauscher
NEW YORK (Reuters Health) Jul 09 - In a study of adults with HIV lipoatrophy, switching from stavudine or zidovudine to abacavir led to a "significant, albeit modest" improvement in objective measures of limb fat, without affecting control of HIV replication.

"This is the first study to convincingly show that lipoatrophy can be improved," lead investigator Dr. Andrew Carr of St. Vincent's Hospital in Sydney, Australia, told Reuters Health. "This is important as lipoatrophy is distressing to patients, potentially stigmatizing and has been significantly linked with poorer adherence to antiretroviral therapy," he added.

Nucleoside reverse transcriptase inhibitor (NRTI)-induced mitochondrial toxicity is thought to underlie HIV lipoatrophy, Dr. Carr and colleagues explain in The Journal of the American Medical Association for July 10th, noting that abacavir may be less toxic to mitochondria.

The investigators had 111 subjects with moderate to severe lipoatrophy being treated with stavudine or zidovudine either continue with those drugs or switch to abacavir 300 mg twice daily, while continuing to take their other antiretroviral drugs.

"All patient subgroups seemed to derive benefit from the switch, even those with more severe lipoatrophy," Dr. Carr told Reuters Health. Dual-energy x-ray absorptiometry showed that patients gained "about 10% of the limb fat they had probably lost," he said.

However, subjective improvements in lipoatrophy did not correlate with objective measures, a finding that may reflect the short followup period. "We are continuing to follow these patients, hopefully for another 2 years, to see if the improvement continues and becomes clinically observable," Dr. Carr said.

The metabolic abnormalities associated with lipoatrophy were not significantly altered by the switch to abacavir, although the study was not statistically powered to look at this, Dr. Carr told Reuters Health.

The switch did not adversely effect plasma HIV RNA levels, a secondary study endpoint, but five subjects (10%) developed hypersensitivity to abacavir.

The fact that lipoatrophy affects upwards of 50% of patients on antiretroviral therapy suggests that "we really need to start exploring prevention," Dr. Carr concluded.

JAMA 2002;288:207-215.



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