7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 13–16 November 2005, Dublin, Ireland

Increase in limb fat after nucleoside analogue cessation is not associated with decreased visceral fat and has different risk factors

H Wand¹, MG Law¹, S Emery¹, DA Cooper^1,2 and A Carr² for the MITOX and ROSEY Study Groups
¹National Centre in HIV Epidemiology and Clinical Research, University of New South Wales; ²St Vincent’s Hospital, Sydney, Australia

Antiviral Therapy 2005; Supplement 3:L5 (abstract no. 3)

OBJECTIVES: No patient characteristic is known to predict lipoatrophy improvement after stopping thymidine nucleoside analogues. It is also unknown whether lipoatrophy and central fat accumulation represent a single process or are at least partially independent. If a single process, lipoatrophy improvements should inversely correlate with changes in visceral adipose tissue (VAT) and risk factors for lipoatrophy and VAT improvements should be similar. We evaluated long-term data from two randomized lipoatrophy trials: MITOX (a switch from d4T [n=85] or AZT [n=26] to abacavir for 24 weeks), and ROSEY (rosiglitazone [RSG; n=53] or placebo [n=55]).

METHODS: All participants (98% male) had moderate-severe lipoatrophy in 1 region (face, arms, legs, buttocks) and were followed for 72 weeks. Factors associated with increasing limb fat (0.5kg) and decreasing VAT were assessed and included HIV duration, baseline age, CD4+ cell count, viral load, body composition and lipid and glycaemic parameters. Changes in limb fat mass (DEXA) were correlated with changes in VAT area (computed tomography).

RESULTS: There was a significant, although relatively weak, positive correlation between the changes in limb fat mass and VAT (week 48: r=0.19, P=0.01; week 72: r=0.25, P=0.001). Limb fat increased by 0.5kg in only 23%, 33% and 41% of patients at 24, 48 and 72 weeks, respectively. The only baseline parameter significantly correlated with a 0.5kg increase in limb fat was higher baseline body mass index (OR 1.6 [95%CI 1.3, 2.0]; P<0.0001); increase in VAT at week 72 was independently associated with 0.5kg increase in limb fat (OR 1.02 [95%CI 1.01, 1.04]; P=0.001). In contrast, independent risk factors at baseline for a decrease in VAT were higher limb fat mass (P<0.0001), lower HDL-C (P=0.002) and higher insulin (P=0.03), as well as a greater decrease in limb fat to week 72 (P<0.0001). Changes in subcutaneous abdominal fat also correlated positively with change in limb fat mass (week 48: r=0.19, P=0.01; week 72: r=0.24, P=0.001).

CONCLUSIONS: An increase in limb fat in men recovering from lipoatrophy is not associated with a reduction in VAT, but rather an increase. Changes in limb fat and VAT also have differing risk factors. Both findings suggest that lipoatrophy and visceral obesity are at least partially independent processes. Lipoatrophy improved in 50% of patients after 18 months and was less likely in those with lower BMI.

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2005-11-13
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