HIV/AIDS: March 15, 2004

John Bartlett, MD


March 15, 2004

In This Article

Interventions for Lipoatrophy

McComsey GA, Ward DJ, Hessenthaler SM, et al. 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. Clin Infect Dis. 2004;38:263-270. The Trial to Assess the Regression of Hyperlactatemia and to Evaluate the Regression of Established Lipodystrophy (TARHEEL) is a 48-week, open-label study of 118 patients with viral suppression (< 400 copies/mL) who developed lipoatrophy after at least 6 months of HAART that included stavudine. Patients were switched from stavudine to abacavir or zidovudine. The patients were assessed at baseline and week 48 by dual-energy x-ray absorptiometry (DEXA) (arm, legs and trunk fat), computed tomographic (CT) scan (subcutaneous abdominal fat and visceral fat), and body image questionnaire. The results showed substantial improvement in the extremities and modest improvements by self-report. The results are summarized in Table 4 , but it should be emphasized that the DEXA readings are the percent increase from baseline and the questionnaire is the percentage of patients who reported improvement.

The authors conclude that this substitution for stavudine results in improvement in lipoatrophy attributed to stavudine.

Comment: The DEXA and CT scan reports seem more impressive than the self-image reports. The question is which are important.

Carr A, Workman C, Carey D, et al. No effect of rosiglitazone for treatment of HIV-1 lipoatrophy: randomised, double-blind, placebo-controlled trial. Lancet. 2004;363:429-438. The authors report the results of therapy with rosiglitazone (4 mg twice daily) for 48 weeks in a randomized, double-blind, placebo-controlled trial of 108 HIV-infected patients with lipoatrophy. Eligibility criteria included limb fat less than 20% of limb tissue or limb fat percentage at least 10% less than truncal fat percentage by DEXA. All participants were receiving HAART. The results showed limb fat increased by 0.14 kg in the group given rosiglitazone and 0.18 kg in the placebo group (P = .40). Thus, there was no benefit in terms of response to correct lipodystrophy, and this treatment was associated with a significant increase in serum triglyceride. The authors conclude that rosiglitazone should not be used for patients with lipoatrophy associated with HAART.