The strange changes in body shape with the loss of fat under the skin (subcutaneous fat) and increased fat in the belly and breasts combined with increased risk of cardiovascular disease and diabetes is collectively called the "HIV lipodystrophy syndrome." Exactly why these changes occur is not clear. Some changes in body shape, such as the loss of subcutaneous fat in the face, arms and legs are most obvious. This side effect has been blamed on the use of a class of drugs called nukes (nucleoside analogues). Examples of nukes include:
An important question not explained in this theory of nuke-related fat loss is why and how can nukes cause fat to disappear from one part of the body (under the skin) and then get deposited in the belly and breasts? Why don't nukes cause the disappearance of fat deeper inside the body?
Nonetheless, some PHAs and their doctors would like to test nuke-free regimens in the hope of either avoiding or reversing the changes in body shape seen in the lipodystrophy syndrome. So doctors in Canada and the European Union are testing nuke-free regimens. None of the studies have been completed, but here are preliminary results from one study in Germany.
Doctors in Heidelberg and elsewhere in Germany recruited 18 HIV positive subjects who had used anti-HIV drugs and were experiencing mitochondrial toxicity or had signs of fat wasting. Subjects were switched from whatever regimen they were currently using to the following combination:
After six months on this regimen, subjects' CD4+ counts and viral loads remained stable. Blood levels of lactate — one measure of the damage caused by nukes — fell. Six subjects discontinued the study because of rash. As a result, researchers suggest that instead of starting with 800 mg/day of efavirenz, the dose should be started at 600 mg and gradually increased. Another drawback to this regimen is the number of pills that needed to be taken — 20 per day.
Although this short-term study shows that a nuke-free regimen is safe, whether or not it can stop or reverse changes in body shape cannot be assessed until more time has passed.
REFERENCE
Gey D, Boit R, Lorenz T, et al. Safety, tolerability and efficacy of an NRTI-free regimen in HIV patients with evidence of mitochondrial toxicity: a pilot study. Sixth International Congress on Drug Therapy in HIV Infection, 17-21 November 2002, Glasgow. Poster 122.
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