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Session 92 Poster Session Switch Studies/Treatment of Lipodystrophy Syndromes Session Time: 4:30-6:30 pm Room 4E-F

703-T. Effects of Niacin upon Fat Expansion in HIV-Positive Patients Who Have the Fat Redistribution Syndrome (FRS) J. Fessel* and S. Follansbee Kaiser Permanente Med. Care Prog., San Francisco, CA Background: In a previous report involving 27 patients, we noted a significant negative correlation between expanded intra-abdominal fat (IAF) and plasma HDL levels (r =-0.40, p =0.04). For this reason, we have investigated the effect upon IAF of raising HDL levels by use of niacin. Here, we describe the results of an open-label, prospective study of niacin treatment in 16 patients having FRS and expanded IAF, who continued taking niacin for >24 weeks (median 1 year). Methods. IAF was measured by single-slice abdominal CT at the L2 level. 16 patients having IAF >70 cm2 were given immediate-release niacin (median dose 3000 mg/day). All used HAART that included Pis. IAF measurements were made at baseline and at most recent follow-up (minimum 24 weeks). Statistical analyses used chi2, Wilcoxon matched-pairs signed-ranks, and Mann-Whitney U tests. P values are 2-sided. Cis are 95%. Results. Mean baseline IAF was 227 (CI, 173 - 266). Median duration of niacin treatment was 364 days (CI, 294 - 400). IAF decreased in 13 (81%) and increased in 3 patients. Overall in the 16 patients, IAF decreased by 16.9% (CI, -33% to -0.8%) (p = 0.01). For those 13 in whom IAF decreased, the mean loss was 26.9% (CI, -39.1% to -14.8%). 9 (56%) of the patients had decreased IAF >20% (mean 35.5%, CI, -50.5% to -18.5%). Percentage decrease of IAF was associated with both the rise in HDL (p = 0.002) and decreased ratio of total cholesterol (TC)/HDL (p = 0.003). Decrease of IAF was also associated with the duration of niacin treatment (p < 0.0001). Initial and final plasma lipids for all 16 patients were: TC, 258 and 235 mg/dL (NS); HDL, 35.4 and 43.1 mg/dL (p = 0.002); TC/HDL ratios, 7.3 and 5.6 (p = 0.008). Conclusions. IAF diminished in most of the patients with FRS who tolerated niacin treatment for >6 months. In the 81% with decreased IAF, their mean decrement was 27%. Duration of treatment with niacin was highly associated with the degree of reduction of IAF. The rise of HDL and the fall in TC/HDL ratio induced by niacin, were associated with decreased IAF.

©2002 9th Conference on Retroviruses and Opportunistic Infections