Does
Discontinuation of Stavudine or Protease Inhibitor Therapy Improve HIV-related
fat Redistribution in Men?
Several
prior studies have found an association between stavudine
(d4T; Zerit) therapy and HIV-related
fat redistribution, in particular fat
loss. In the current observational, retrospective study, researchers
at the Toulouse Hospital in Toulouse France sought to determine whether discontinuation
of stavudine or protease
inhibitor therapy improves HIV-related fat distribution in men.
The
investigators examined medical records from Purpan University Hospital and La
Grave University Hospital, Toulouse, France and selected 80 men with HIV infection
treated with antiretrovirals and 151 healthy male controls matched for age. In
part 1 of the study, body composition and fat distribution of the HIV-infected
men were compared by dual energy x-ray absorptiometry (DEXA) with those of the
controls to determine whether body fat distribution is altered in HIV-infected
men. In
part 2 of the study, modifications of body composition and fat distribution in
45 of the 80 patients were analyzed. These 45 patients had been exposed to antiretroviral
drugs, including stavudine and a protease inhibitor, for at least 5 months before
the first of two DEXA assessments. They
received three different treatment strategies for several months. In group 1,
stavudine was withdrawn; in group 2, protease inhibitor was discontinued, and
in group 3, stavudine plus protease inhibitor were continued. Results 
Group
1 showed a significant fat gain in the lower extremities 31.7 +/- 5.9 months after
stavudine discontinuation (p<0.0001).
Group 2 did not show any significant modification
of total body, lower limb, or trunk fat despite protease inhibitor discontinuation
for 35.2 +/- 6.6 months.
Findings were similar for group 3, who continued
receiving stavudine-protease inhibitor therapy for 21.2 +/- 12.8 months.
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In
conclusion, the authors write, “These data suggest that long-term withdrawal of
stavudine from the antiretroviral therapy regimen may be associated with significant
improvement in lipoatrophy
in the lower extremities, whereas long-term protease inhibitor withdrawal did
not modify fat distribution. Service de Pharmacologie Clinique, Cent re Midi-Pyrenees
de Pharmacovigilance, de Pharmacoepidemiologie et d'Informations sur le Medicament,
Faculte de Medecine, Hopitaux de Toulouse, Toulouse, France. 05/05/06 Reference
N
Tavassoli, H Bagheri, A Sommet, and others. Effects of discontinuing stavudine or protease
inhibitor therapy on human immunodeficiency virus-related fat redistribution evaluated
by dual-energy x-ray absorptiometry. Macotherapy 26(2): 154-161. February 2006.
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