Rosiglitazone improves lipoatrophy in patients receiving thymidine-sparing regimens.
OBJECTIVE
Thymidine reverse transcriptase inhibitors (tNRTI) are strong inhibitors of PPAR-gamma and clearly implicated as a cause of lipoatrophy. Thiazolidenediaones (TZD), potent PPAR-gamma agonists, would be expected to be beneficial in HIV lipoatrophy, but prior studies have been conflicting. None specifically excluded the use of tNRTIs. We report the first study in individuals treated with tNRTI-sparing regimens using a TZD for treatment of HIV lipoatrophy.


METHODS
This double-blind, placebo-controlled study evaluated limb fat in HIV-infected individuals with lipoatrophy who discontinued tNRTI at least 24 weeks prior to enrollment.


METHODS
Individuals were randomized to rosiglitazone vs. placebo for 48 weeks. Dual energy X-ray absorptiometry (DEXA)-scans and fasting metabolic assessments were serially performed.


RESULTS
We enrolled 71 individuals, 17% were female and 51% white. Baseline characteristics were similar between groups except for higher total cholesterol in the placebo group (P = 0.04). At 48 weeks, limb fat (grams) increased significantly (P = 0.02) more in the rosiglitazone than in the placebo group: median (IQR) 448 (138, 1670) vs. 153 (-100, 682), respectively. Of lipids parameters, only total cholesterol increased significantly more in the rosiglitazone group (P = 0.008). Prevalence of metabolic syndrome and total bone mineral density did not change between or within groups.


CONCLUSIONS
In the absence of tNRTI, rosiglitazone significantly improves lipoatrophy without deleterious effect on bone mineral density. Total cholesterol, but not triglycerides, significantly increased in the rosiglitazone arm. The glitazones may be a promising addition for accelerating fat recovery in individuals who had switched off tNRTI and remain with significant lipoatrophy.
Tungsiripat
Marisa
M
Cleveland Clinic, Ohio, USA.
Bejjani
Dalia El
DE
Rizk
Nesrine
N
O'riordan
Mary Ann
MA
Ross
Allison C
AC
Hileman
Corrilynn
C
Storer
Norma
N
Harrill
Danielle
D
McComsey
Grace A
GA
D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000187:drug effects*; D000328:Adult; D002784:Cholesterol / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000188:drug therapy* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D047495:PPAR gamma / Q000819:agonists / Q000037:antagonists & inhibitors; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects / Q000627:therapeutic use*; D013936:Thymidine / Q000037:antagonists & inhibitors
D047495:PPAR gamma; D018894:Reverse Transcriptase Inhibitors; D045162:Thiazolidinediones; D000077154:Rosiglitazone; D002784:Cholesterol; D013936:Thymidine
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