AEGiS-Glasgow [PL12.3] The management of lipoatrophy

Eighth International Congress on Drug Therapy in HIV Infection

Glasgow, UK - 12-16 November 2006

[PL12.3] THE MANAGEMENT OF LIPOATROPHY

Int Cong Drug Therapy HIV 2006 Nov 12-16;8:Abstract No. PL12.3

Jussi Sutinen
Division of Infectious Diseases, University of Helsinki, Finland

PURPOSE OF THE STUDY Lipoatrophy (LA) is a severe side effect of HAART, which may lead to psychological distress and poor adherence to medication.

For any patient with signs of LA, a thymidine analogue (stavudine, zidovudine) should be replaced either by abacavir or tenofovir if the switch is considered virologically safe. Switching away from a protease inhibitor does not correct LA.

Treatment of LA with rosiglitazone, an insulin sensitizing agent, has given disappointing results. Although it has improved insulin sensitivity, it has also increased blood lipids. In one study, pioglitazone increased limb fat mass without affecting blood lipids. The fat-inducing effect of glitazones may be more pronounced if the ongoing HAART does not include stavudine. Uridine corrects thymidine-analogue induced toxicity in adipocytes in vitro. In a placebo-controlled trial, uridine increased limb fat during ongoing thymidine-analogue therapy. Pravastatin has been shown to increase limb fat in a placebo-controlled trial in hypercholesterolemic patients.

Surgical implants and injectable fillers are used as reconstructive therapy of facial LA. Use of implants (e.g. autologous fat/dermis) requires invasive surgery. Injectable fillers are either bioabsorbable (e.g. poly-L-lactic acid, hyaluronic acid) or permanent (e.g. silicone, polyalkyl-amide, polymethylmetacrylate). Treatment with bioabsorbable fillers must be repeated over time, but this is also an important safety factor, since they can not cause permanent foreign body reactions, migration or other complications potentially associated with permanent fillers.

Since the treatment of LA is often unsatisfactory, strategies to prevent LA must be emphasized. Some nucleoside analogues (lamivudine, emtricitabine, abacavir, tenofovir) have not been associated with LA. The data on whether a preventive switch away from zidovudine is indicated are still not available. It is also important to limit the use of other agents known to decrease subcutaneous fat such as metformin, growth hormone and anabolic steroids.

Plenary Session: Adverse Events II

2006-11-12
PL12.3

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