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Reversibility of Peripheral Fat Wasting (Lipoatrophy) on Stopping Stavudine Therapy T. SAINT-MARC*, M. PARTISANI, I. POIZOT-MARTIN, and J. L. TOURAINE.
E. Herriot Hosp., Lyon, France Background: Early reports linked lipodystrophy syndrome to therapy with HIV protease inhibitors (PI). The more recent observations of fat wasting developing in patients who have never had Pls implicate an independent effect of NRTI therapy.
Objectives: to assess the effects of stavudine therapy discontinuation on metabolic and clinical anormalities in ARV-experienced patients suffering lipoatrophy (LA).
Methods: Body composition (BIA), skinfold thickness (3 sites), regional fat distribution (CT scan), fasting lipid and glycemic parameters (OGTT), CD4 counts and plasma HIV RNA were evaluated over 9 months in 36 patients (median follow up: 11 months).
Results: In those stopping d4T there was a significant improvement in triglycerides (–29%) and serum lactates (–37%) while cholesterol, glucose and insulin levels remained unchanged. Abdominal and midthigh subcutaneous fat area increased by 32% and 36%, fat mass (expressed in %); biceps, triceps and suprailiac skinfold increased by 38%, 23°'0, 27%, 36% respectively. Eleven patients reported a major improvement in their fat distribution (4 admitted to have their body shaped as prior to body changes) and 21 reported a partial improvement.
Conclusion: These data suggest that ceasing stavudine therapy for 9 months resulted in improvements in metabolic and body fat abnormalities. The reversibility of the symptoms further supports the potential role of stavudine in the pathogenesis of a peripheral fat wasting syndrome.
Key Words: fat wasting, lipoatrophy, stavudime
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