A 6-month interruption of antiretroviral therapy improves adipose tissue function in HIV-infected patients: the ANRS EP29 Lipostop Study.
OBJECTIVE
To examine the reversibility of adipose tissue alterations in HIV-infected patients after a 6-month interruption of antiretroviral therapy (ART).


METHODS
Forty HIV-infected patients on stable effective ART were enrolled, 33 of them completed the study. Patients underwent a physical examination, laboratory tests and needle biopsy of subcutaneous abdominal adipose tissue both at inclusion and at month 6. Changes in fat morphology, mitochondrial DNA (mtDNA) content and gene expression were examined in 29, 23 and 20 patients, respectively.


RESULTS
Body fat distribution was not clearly modified at month 6. Adipose tissue inflammation improved markedly, with fewer infiltrating macrophages and fewer tumour necrosis factor alpha (TNFalpha)- and interleukin 6 (IL6)-expressing cells. Expression of peroxisome proliferator-activated receptor gamma (PPAR-gamma) and of markers of mitochondrial function and biogenesis (cytochrome oxidase 2 and PPAR-gamma coreceptor 1alpha) improved after protease inhibitor (PI) withdrawal. In patients who stopped taking stavudine or zidovudine, the number of TNFalpha- and IL6-expressing cells was lower at month 6 than at month 0, and so was CD68 expression, a macrophage marker. Adipocyte mitochondrial status also improved, with lower mitochondrial density and cytochrome oxidase 4 mRNA levels, and higher mtDNA content. Sterol regulatory element binding protein 1 mRNA levels increased, reflecting better adipocyte differentiation.


CONCLUSIONS
A 6-month ART interruption markedly improved adipose tissue functions, although fat distribution did not visibly change. Stavudine and zidovudine were associated with marked inflammation, which improved when these drugs were withdrawn; they also had a negative effect on differentiation and mitochondrial status. PIs were also associated with altered adipocyte differentiation and mitochondrial status. These data clearly show the detrimental effect of antiretroviral drugs, in particular thymidine analogues, on adipose tissue and argue for switch strategies sparing these drugs.
Kim
Min Ji
MJ
inserm, U680, Paris, F-75012, France.
Leclercq
Pascale
P
Lanoy
Emilie
E
Cervera
Pascale
P
Antuna-Puente
Barbara
B
Maachi
Mustapha
M
Dorofeev
Elena
E
Slama
Laurence
L
Valantin
Mare Antoine
MA
Costagliola
Dominique
D
Lombes
Anne
A
Bastard
Jean-Philippe
JP
Capeau
Jacqueline
J
D000273:Adipose Tissue / Q000378:metabolism / Q000503:physiopathology*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D004272:DNA, Mitochondrial / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000503:physiopathology*; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000378:metabolism; D008264:Macrophages / Q000276:immunology / Q000378:metabolism; D008297:Male; D008928:Mitochondria / Q000378:metabolism; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D028761:Withholding Treatment
D044966:Anti-Retroviral Agents; D004272:DNA, Mitochondrial; D017320:HIV Protease Inhibitors; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha