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

IMPROVEMENT IN LIPOATROPHY FOLLOWING SWITCHING FROM STAVUDINE TO DIDANOSINE: 48 WEEK FOLLOW-UP

C Bowonwatanuwong¹, P Seur² and J Waiwaravut^1
1 Chonburi Hospital, Thailand; ² HEARTT 2000 (Help, Ensure AIDS, Rescue Together in Thailand) Pattaya, Thailand

Antiviral Therapy 2005; Supplement 3:L26 (abstract no. 39)

BACKGROUND: The current heavy use of stavudine (d4T) in Thailand as the backbone of HAART regimen resulted in lipoatrophic changes in 17% of patients after 2 years. We hypothesized that switching d4T to non-thymidine NRTI, the most practical and least costly in Thailand being generic didanosine (ddI), might alleviate these stigmatizing morphological complications.

METHODS: This was a 48-week observational study enrolling 27 subjects who were lipoatrophic as a result of using d4T and were subsequently treated with generic ddI instead of d4T. Follow-up to assess visible morphological changes and metabolic parameters was made at week 4, week 12, week 24, week 36 and week 48.

RESULTS: A total of 27 patients (15 female, 12 male), median age 39.7 years, were recruited. Mean duration from start of d4T use until lipoatrophy manifestation was 17.2 months. Mean body weight increased from 54.0kg (wk 0) to 54.8kg (wk 24) and 58.2 kg (wk 48). Of the 27 patients, 25 were satisfied with improvement on their lipoatrophy. Median CD4 cell count increased from 277 cells (wk 0) to 357 cells (wk 24) and 408 cells (wk 48). Of 17 patients who were able to access viral load assay, 15 had undetectable viral load level, and five of these patients also had peripheral fat content assessed by DEXA scan.

CONCLUSIONS: Switching from d4T to ddI resulted in marked improvement in the symptoms of lipoatrophy after 1-year follow-up and correlated with the satisfactory immunological and virological responses. Further studies with a larger number of patients and objective measurement of mitochondrial study, for example peripheral fat content by DEXA scan and subcutaneous adipose mitochondrial DNA content, will be warranted.

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2005-11-13
39

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