Stopping d4T or AZT may reverse fat loss - slowly

at the Annual Conference of the Australasian Society for HIV Medicine (4-7thOctober) and the Sixth International Congress on AIDS in Asia and the Pacific (6-10thOctober), Melbourne, Australia.

Reversal of fat loss associated with the thymidine analogues (AZT and d4T) may take four to five years after cessation of the drugs, Dr Andrew Carr told the Annual Conference of the Australasian Society for HIV Medicine (ASHM) in Melbourne, Australia.

This claim was based on 24-week data from the MITOX study – a multicentre, open label study conducted in Melbourne and Sydney. One hundred and five HIV-infected people with fat loss (lipoatrophy) were randomised to continue current therapy or to replace d4T or AZT with abacavir. All participants were on stable therapy with fully suppressed viral loads and lipoatrophy affecting several bodily regions. Over 80% were taking d4T.

Ten percent of the abacavir group experienced a hypersensitivity reaction and ceased therapy. Nevertheless, intention-to-treat analysis showed significant improvements in limb, thigh and subcutaneous fat in the switch group compared to the control group. There were non-significant downward trends in the amount of visceral adipose tissue and lactate levels.

However, Dr Carr reported that the increase in subcutaneous fat was exceedingly gradual and may take four to five years to normalise based on the rate of fat restoration in this study. Neither patients nor physicians reported any change in body fat.

Despite the slow rate of fat recovery, Dr Carr emphasised that this is the first study to show a successful treatment for lipoatrophy. “I tell my patients that the data are encouraging,” Dr Carr said.