Body
Fat
and
Other
Metabolic
Effects
of
Atazanavir
and
Efavirenz,
Each
Administered
in
Combination
with
Zidovudine
plus
Lamivudine,
in
Treatment-naive
HIV
Patients
Protease
inhibitor
treatment
of
HIV
positive
individuals
has
been
linked
to
the
development
of
lipodystrophy.
The
effects
of
atazanavir
(Reyataz)
on
body
fat
distribution
and
related
metabolic
parameters
were
examined
in
antiretroviral-naive
patients.
HIV-positive
patients
with
CD4
cell
counts
100
cells/mm3
were
randomized
to
1
of
2 treatment
arms:
(1)
atazanavir,
400
mg
given
once
daily,
plus
efavirenz
(Sustiva)
placebo;
or
(2)
efavirenz,
600
mg
given
once
daily,
plus
atazanavir
placebo.
Each
drug
was
administered
with
fixed-dose
zidovudine
(300
mg)
and
lamivudine
(150
mg)
[Combivir]
given
twice
daily,
and
patients
were
treated
for
at
least
48
weeks.
Fat
distribution
measurements
(visceral
adipose
tissue
[VAT],
subcutaneous
adipose
tissue
[SAT],
and
total
adipose
tissue
[TAT],
as
measured
by
computed
tomography
were
performed;
and
appendicular
fat,
truncal
fat,
and
total
fat
levels,
as
measured
by
dual-energy
X-ray
absorptiometry)
were
also
collected.
Metabolic
measurements
(cholesterol
and
fasting
triglyceride
levels),
and
measurements
of
insulin
resistance
(fasting
glucose
and
fasting
insulin
levels)
were
made
at
baseline
and
at
week
48
of
treatment
for
a
subgroup
of
111
atazanavir
recipients
and
100
efavirenz
recipients.
Results 
Atazanavir
and
efavirenz
treatments
resulted
in
minimal
to
modest
increases
in
fat
accumulation,
as
measured
by
VAT,
SAT,
TAT,
appendicular
fat,
truncalfat,
and
total
fat
levels;
Results
were
comparable
in
both
arms.
In
addition,
atazanavir
was
associated
with
none
of
the
metabolic
abnormalities
seen
with
many
other
protease
inhibitors.
In
conclusion,
the
authors
write,
“Use
of
atazanavir
for
48
weeks
neither
resulted
in
abnormal
fat
redistribution
in
antiretroviral-naive
patients
nor
induced
other
metabolic
disturbances
commonly
associated
with
HIV-related
lipodystrophy.
Longer-term
assessments
(e.g.,
at
96
weeks)
will
be
important
to
confirm
these
findings.” Discussion No
meaningful
changes
from
baseline
were
observed
on
either
regimen
in
the
ratios
of
appendicular
fat
to
total
fat
or
of
truncal
fat
to
total
fat.
Adipose
tissue
ratios
also
remained
relatively
constant,
consistent
with
DEXA
scan
results.
Particularly
important,
the
ratio
of
VAT
level
to
TAT
level
a recognized
marker
of
central
adiposity
remained
stable,
at
0.3
in
both
treatment
groups. In
line
with
previous
findings
and
in
contrast
with
results
for
other
protease
inhibitors,
atazanavir
did
not
result
in
significant
increases
in
total
cholesterol,
fasting
LDL
cholesterol,
non-HDL
cholesterol,
or
fasting
triglyceride
levels.
In
addition,
atazanavir
did
not
result
in
substantive
increases
in
fasting
glucose,
fasting
insulin,
or
insulin
resistance
indices. Jemsek
Clinic,
Huntersville,
North
Carolina;
Bristol-Myers
Squibb,
Wallingford,
Connecticut;
Bristol-Myers
Squibb,
Princeton,
New
Jersey;
Hospital
General
San
Juan
de
Dios,
Guatemala,
Guatemala
City;
Consultorio
Royal
Center,
Panama
City,
Panama;
Hospital
Clínico
de
La
Pontificia
Universidad
Católica,
Santiago,
Chile;
Ospedale
degli
Infermi,
Rimini,
Italy;
and
Federal
AIDS
Center,
Moscow,
Russia. 01/17/05 Reference
J G Jemsek
and
others.
Body
Fat
and
Other
Metabolic
Effects
of
Atazanavir
and
Efavirenz,
Each
Administered
in
Combination
with
Zidovudine
plus
Lamivudine,
in
Antiretroviral-Naive
HIV-Infected
Patients.
Clinical
Infectious
Diseases 42(2):
273-280.
January
15,
2006.
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