Document Detail


Rosiglitazone improves lipoatrophy in patients receiving thymidine-sparing regimens.
MedLine Citation:
PMID:  20453626     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
DESIGN: 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.
CONCLUSION: 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.
Authors:
Marisa Tungsiripat; Dalia El Bejjani; Nesrine Rizk; Mary Ann O'riordan; Allison C Ross; Corrilynn Hileman; Norma Storer; Danielle Harrill; Grace A McComsey
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AIDS (London, England)     Volume:  24     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-18     Completed Date:  2010-12-30     Revised Date:  2011-07-28    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  1291-8     Citation Subset:  IM; X    
Affiliation:
Cleveland Clinic, Ohio, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00367744
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MeSH Terms
Descriptor/Qualifier:
Absorptiometry, Photon
Adipose Tissue / drug effects*
Adult
Cholesterol / blood
Double-Blind Method
Female
HIV Infections / blood,  drug therapy
HIV-Associated Lipodystrophy Syndrome / chemically induced,  drug therapy*,  metabolism
Humans
Male
Middle Aged
PPAR gamma / agonists,  antagonists & inhibitors
Reverse Transcriptase Inhibitors / adverse effects,  therapeutic use*
Thiazolidinediones / adverse effects,  therapeutic use*
Thymidine / antagonists & inhibitors
Grant Support
ID/Acronym/Agency:
1UL 1RR024989/RR/NCRR NIH HHS; AI-060484/AI/NIAID NIH HHS; AI-070078/AI/NIAID NIH HHS; AI-36219/AI/NIAID NIH HHS; K23 AI070078-04/AI/NIAID NIH HHS; K23 AI070078-05/AI/NIAID NIH HHS; R01 AI060484-01A2/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/PPAR gamma; 0/Reverse Transcriptase Inhibitors; 0/Thiazolidinediones; 122320-73-4/rosiglitazone; 50-89-5/Thymidine; 57-88-5/Cholesterol
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