HIV-Associated Lipodystrophy Syndrome

Publication Title: 
Sexually Transmitted Infections

OBJECTIVES: To investigate the psychosocial impact of lipodystrophy on the lifestyles of HIV positive patients on highly active antiretroviral therapy (HAART). METHODS: In-depth interviews were conducted with 14 HIV positive patients on HAART at an outpatient sexually transmitted infections (STI) and HIV clinic in central London. Qualitative data from interview transcripts were analysed using grounded theory to elicit key categories and subcategories.

Author(s): 
Power, R.
Tate, H. L.
McGill, S. M.
Taylor, C.
Publication Title: 
Journal of Alternative and Complementary Medicine (New York, N.Y.)

BACKGROUND: Complementary and alternative medicine (CAM) use is common among some patients who test positive for human immunodeficiency virus (HIV). Changes in body-fat distribution can occur in some patients on prolonged highly active antiretroviral therapy. Currently, there are fewer effective treatments for the condition. Patients with lipodystrophy may be turning to CAM. OBJECTIVE: The objective was to investigate the prevalence and perceived benefit of CAM use for perceived body-shape changes among a cohort of HIV-positive patients.

Author(s): 
Cho, Minhee
Ye, Xioabu
Dobs, Adrian
Cofrancesco, Joseph
Publication Title: 
Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America

Changes in fat distribution, dyslipidemia, disordered glucose metabolism, and lactic acidosis have emerged as significant challenges to the treatment of human immunodeficiency virus (HIV) infection. Over the past decade, numerous investigations have been conducted to better define these conditions, identify risk factors associated with their development, and test potential therapeutic interventions.

Author(s): 
Wohl, D. A.
McComsey, G.
Tebas, P.
Brown, T. T.
Glesby, M. J.
Reeds, D.
Shikuma, C.
Mulligan, K.
Dube, M.
Wininger, D.
Huang, J.
Revuelta, M.
Currier, J.
Swindells, S.
Fichtenbaum, C.
Basar, M.
Tungsiripat, M.
Meyer, W.
Weihe, J.
Wanke, C.
Publication Title: 
The Journal of Infectious Diseases

BACKGROUND: Antiretroviral therapy (ART)-associated lipoatrophy involves mitochondrial dysfunction. Iron metabolism impacts mitochondrial function and oxidative stress. Mitochondrial haplogroups and hemochromatosis gene (HFE) polymorphisms have been associated with ART-induced neuropathy. We assessed relationships between these variants and lipoatrophy. METHODS: The AIDS Clinical Trials Group 384 study randomized ART-naive individuals to receive didanosine-stavudine or zidovudine-lamivudine, combined with efavirenz and/or nelfinavir.

Author(s): 
Hulgan, Todd
Tebas, Pablo
Canter, Jeffrey A.
Mulligan, Kathleen
Haas, David W.
Dubé, Michael
Grinspoon, Steven
Robbins, Gregory K.
Motsinger, Alison A.
Kallianpur, Asha R.
AIDS Clinical Trials Group 384 and A5005s Study Teams
Publication Title: 
Toxicologic Pathology

Metabolic complications associated with HIV infection and treatment frequently present as a relative lack of peripheral adipose tissue associated with dyslipidemia and insulin resistance. In this review we explain the connection between abnormalities of intermediary metabolism, observed either in vitro or in vivo, and this group of metabolic effects. We review molecular mechanisms by which the HIV protease inhibitor (PI) class of drugs may affect the normal stimulatory effect of insulin on glucose and fat storage.

Author(s): 
Flint, Oliver P.
Noor, Mustafa A.
Hruz, Paul W.
Hylemon, Phil B.
Yarasheski, Kevin
Kotler, Donald P.
Parker, Rex A.
Bellamine, Aouatef
Publication Title: 
The Journal of Antimicrobial Chemotherapy

BACKGROUND: Switching a thymidine analogue to a non-thymidine analogue or changing to a nucleoside-sparing regimen has been shown to partially reverse peripheral lipoatrophy. The current study evaluated both approaches.

Author(s): 
Tebas, P.
Zhang, J.
Häfner, R.
Tashima, K.
Shevitz, A.
Yarasheski, K.
Berzins, B.
Owens, S.
Forand, J.
Evans, S.
Murphy, R.
Publication Title: 
Antiviral Therapy

BACKGROUND: We aimed to determine whether statin exposure in antiretroviral-treated individuals is associated with increases in hip circumference compared with HIV treatment without concomitant statin use. METHODS: This was a prospective multicentre cohort study involving individuals who had received antiretroviral therapy for at least 40 weeks and who were enrolled in the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. There were 2,223 participants in the statin-unexposed group and 371 in the statin-exposed group.

Author(s): 
Brown, Todd T.
Smurzynski, Marlene
Wu, Kunling
Bosch, Ronald J.
McComsey, Grace A.
Publication Title: 
AIDS (London, England)

BACKGROUND: Lipoatrophy is prevalent on thymidine nucleoside reverse transcriptase inhibitors (tNRTIs). A pilot trial showed that uridine (NucleomaxX) increased limb fat. METHODS: A5229 was a multicenter trial in which HIV-infected individuals with lipoatrophy on tNRTI regimens were randomized to NucleomaxX or placebo. Primary endpoint was change in limb fat from baseline to week 48. The study was powered to detect 400-g difference between arms at week 48. A stratified Wilcoxon rank-sum test was used to assess between-arm differences.

Author(s): 
McComsey, Grace A.
Walker, Ulrich A.
Budhathoki, Chakra B.
Su, Zhaohui
Currier, Judith S.
Kosmiski, Lisa
Naini, Linda G.
Charles, Stéphannie
Medvik, Kathy
Aberg, Judith A.
AIDS Clinical Trials Group A5229 Team
Publication Title: 
Nature Reviews. Endocrinology

Morphologic and metabolic abnormalities, including subcutaneous adipose tissue wasting, central adipose tissue accumulation, dyslipidemia and disorders of glucose metabolism are common among HIV-infected patients receiving highly active antiretroviral therapy (HAART) and contribute to the risk of cardiovascular disease in this population. The pathogenesis of these disorders is due to complicated interactions between effects of chronic HIV infection, HAART medications and patient factors, including genetic susceptibility.

Author(s): 
Brown, Todd T.
Glesby, Marshall J.
Publication Title: 
Antiviral Therapy

BACKGROUND: Lipoatrophy modestly improves when the thymidine analogue nucleoside reverse transcriptase inhibitor (tNRTI) is removed. In vitro, uridine (NucleomaxX(®); Pharma Nord, Vojens, Denmark) reversed tNRTI mitochondrial toxicity. METHODS: All patients had lipoatrophy on a tNRTI-containing regimen with HIV RNA<400 copies/ml. A randomized 48-week study switched patients from tNRTI to tenofovir (TDF) or added uridine (continuing tNRTI).

Author(s): 
McComsey, Grace A.
O'Riordan, MaryAnn
Choi, Julia
Libutti, Daniel
Rowe, David
Storer, Norma
Harrill, Danielle
Gerschenson, Mariana

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