title: The effects of intermittent, CD4-guided antiretroviral therapy on body composition and metabolic parameters.
abstract: OBJECTIVE
  To assess the effects of decreased antiretroviral therapy exposure on body fat and metabolic parameters.
  
  
  METHODS
  Substudy of the Strategies for Management of Anti-Retroviral Therapy study, in which participants were randomized to intermittent CD4-guided [Drug Conservation (DC) group] or to continuous [Viral Suppression (VS) group] antiretroviral therapy.
  
  
  METHODS
  Participants at 33 sites were coenrolled in the Strategies for Management of Anti-Retroviral Therapy Body Composition substudy. Regional fat was assessed annually by whole-body dual-energy X-ray absorptiometry and abdominal computed tomography. Fasting metabolic parameters were assessed at months 4, 8, and annually. Treatment groups were compared for changes in fat and metabolic markers using longitudinal mixed models.
  
  
  RESULTS
  Two hundred and seventy-five patients were randomized to the DC (n = 142) or VS (n = 133) group and followed for a median of 2.0 years. By month 12, limb fat (DC-VS difference 9.8%, 95% confidence interval 3.5-16.1; P = 0.003) and subcutaneous abdominal fat (DC-VS difference 14.3 cm, 95% confidence interval -0.1 to 28.7; P = 0.05) increased in the DC group. There was no treatment difference in visceral abdominal fat (DC-VS difference -2.1%, 95% confidence interval -13.5 to 9.4; P = 0.72). Lipids significantly decreased in the DC group by month 4 and treatment differences persisted throughout follow-up (P < or = 0.001). By 12 months, hemoglobin A1C increased in the DC (+0.3%) and remained stable in the VS group (P = 0.003); the treatment difference remained significant throughout follow-up (P = 0.02).
  
  
  CONCLUSIONS
  After 12 months, intermittent antiretroviral therapy increased subcutaneous fat, had no effect on visceral abdominal fat, decreased plasma lipids, and increased hemoglobin A1C compared with continuous antiretroviral therapy.
authors.affiliation: Infectious Diseases Unit, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain. esteban@fundsoriano.es
authors.forename: Esteban
authors.initials: E
authors.lastname: Martinez
authors.forename: Fehmida
authors.initials: F
authors.lastname: Visnegarwala
authors.forename: Birgit
authors.initials: B
authors.lastname: Grund
authors.forename: Avis
authors.initials: A
authors.lastname: Thomas
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Judith
authors.initials: J
authors.lastname: Shlay
authors.forename: Fraser
authors.initials: F
authors.lastname: Drummond
authors.forename: Daniel
authors.initials: D
authors.lastname: Pearce
authors.forename: Simon
authors.initials: S
authors.lastname: Edwards
authors.forename: Peter
authors.initials: P
authors.lastname: Reiss
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Sadr
authors.forename: Andrew
authors.initials: A
authors.lastname: Carr
mesh_terms: D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000000981:diagnostic imaging / Q000187:drug effects*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D001823:Body Composition / Q000187:drug effects*; D018791:CD4 Lymphocyte Count; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D050151:Subcutaneous Fat / Q000187:drug effects; D050507:Subcutaneous Fat, Abdominal / Q000187:drug effects
chemical_list: D044966:Anti-Retroviral Agents