[749] REDUCTION OF d4T DOSAGE IMPROVES LIPOATROPHY WITHOUT VIROLOGIC FAILURE

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] REDUCTION OF d4T DOSAGE IMPROVES LIPOATROPHY WITHOUT VIROLOGIC FAILURE

[AUTHOR(S):] M Hanvanich^1,2, V Prasanthai¹, P Riengchan¹, K Arunyingmongkol¹, P Intalapaporn¹, N Hiransuthikul¹, C Suankratay¹ and W Kulwichit¹
¹Chulalongkorn University; and ²Bumrungrad Hospital, Bangkok, Thailand

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 749
Antiviral Therapy 2003; 8(Suppl. 1):S392-S393

[ABSTRACT:] Previous studies link lipoatrophy to antiretroviral drugs especially d4T. The d4T-related lipoatrophy may be due to mitochondrial toxicity which we think may be caused by overdosage of the current recommended dose. We, therefore, reduced the dosage of d4T in 80 patients treated with d4T containing HAART regimens who developed lipoatrophy and had sustained viral suppression for more than 6 months. Lipodystrophy signs were observed and assessed clinically. CD4 and viral load were tested every 3–6 months. All the patients have excellent compliance. 54 males, 26 females, mean age 46.5 years (range 26–91). All patients were receiving d4T, other NRTI (72 with 3TC, 8 with ddI) and NNRTI (46 with EFV) or PI (15 with NFV, 11 with IDV, 4 with IDV/RTV, 2 with RTV) or ABC (2 cases). All developed lipoatrophy which was assessed clinically to be mild (slightly decreased facial fat and limbs fat) in 22 cases, moderate (easily noticeable loss of facial fat and limbs fat) in 41 cases and severe (mark atrophy of face and limbs ) in 17 cases. At the time of d4T dosage reduction, mean CD4 was 334 cells/mm³ (range 35–925). The d4T dosage was reduced from 40 to 30 mg bid in 40 cases with BW >60 kg, mean 67.2 kg (range 60–101). 40 cases with BW <60 kg, mean 50.4 kg (range 32–59), reduced d4T from 30 to 20 mg. All the patients have improvement of lipoatrophy. The ones that we decreased d4T at the early stage of lipoatrophy improved much faster than the ones which moderate or severe lipoatrophy. All remained HIV suppressed of <50 copies/ml up to median time of 93 weeks (range 2–309). When the improvement of lipoatrophy was very slow or not satisfactory the d4T dosage was further reduced to 50% or less of the current recommended dosage in 56 cases with good results and good virologic control of <50 copies/ml up to median time of 86 weeks (range 2–309). The patients have body weight gains of 0.78 kg (range –14 to 9.5) in mild group, 2.2 kg (range –4 to 19.9) in moderate group and 1.1 kg (range –6 to 6) in severe group. At the time of analysis of this observational cohort, eight cases decided to stop d4T, five switched to ABC, 27 of the PI-treated cases switched to EFV.

Conclusions: Reduced d4T dosage in patients with suppressed HIV virus improved lipoatrophy without affecting control of the virus. Early reduction of d4T dosage when lipoatrophy develops is recommended where other options are not available.

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