Switching to nevirapine decreases insulin levels but does not improve subcutaneous adipocyte apoptosis in patients with highly active antiretroviral therapy-associated lipodystrophy.
Subcutaneous adipocyte apoptosis occurs in lipotrophic areas of patients with highly active antiretroviral therapy (HAART)-associated lipodystrophy. Fourteen patients with HAART-associated lipodystrophy had 2 subcutaneous biopsies for evidence of adipocyte apoptosis, the second after a randomized change to nevirapine (n=8) or after remaining on a regimen of indinavir-based HAART (n=6). Apoptosis was assessed by the terminal deoxynucleotidyl transferase dUTP-digoxigenin nick end-labeling method. Patients who were switched to nevirapine had a significant decrease in insulinemia and a significant increase in the glucose:insulin ratio. Overall, subcutaneous adipocyte apoptosis increased in 3 patients who were switched to nevirapine and in 3 who continued to receive indinavir but decreased in 2 patients switched to nevirapine and another 2 who continued to receive indinavir. Subcutaneous adipocyte apoptosis continues to occur in lipotrophic areas of patients with HAART-associated lipodystrophy despite switching from indinavir to nevirapine, suggesting that such a strategy will be useless for reversal of lipoatrophy.
Domingo
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P
Department of Internal Medicine, Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Avgda. Sant Antoni M. Claret, 167, 08025 Barcelona, Spain. pere.domingo@uab.es
Matías-Guiu
X
X
Pujol
R M
RM
Domingo
J C
JC
Arroyo
J A
JA
Sambeat
M A
MA
Vázquez
G
G
D017667:Adipocytes / Q000473:pathology*; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D017209:Apoptosis; D001786:Blood Glucose; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D020287:In Situ Nick-End Labeling; D019469:Indinavir / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000097:blood*; D008060:Lipodystrophy / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use
D019380:Anti-HIV Agents; D001786:Blood Glucose; D007328:Insulin; D018894:Reverse Transcriptase Inhibitors; D019469:Indinavir; D019829:Nevirapine