Selected highlights from the 4th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV
Because nukes have been suspected of damaging mitochondria, the use of some of these drugs may be linked to fat wasting. This is why some doctors and their patients are interested in testing combination therapy that does not include nukes (nuke-sparing). Researchers in Canada (Vancouver and Toronto) have been studying combinations of nuke-sparing regimens, such as the protease inhibitor Kaletra with the non-nuke nevirapine, to assess this combination's effect on the lipodystrophy syndrome. Similarly, researchers in Ottawa have been testing another combination — ritonavir-boosted saquinavir (PIs) with the non-nuke efavirenz. Complete details from these studies have not been released.
Meanwhile, researchers in the Netherlands have reported preliminary, six-month data from their study of another nuke-sparing regimen: ritonavir-boosted indinavir (PIs) and efavirenz. In this study, all subjects received the following regimen:
Some subjects also received standard doses of d4T.
The researchers analysed data on 36 subjects, none of whom had previously been exposed to anti-HIV therapy before entering the study. In measuring the level of DNA in mitochondria within white blood cells, they found some surprising results. After six months, levels of mitochondrial DNA doubled in both study groups. The researchers speculate that this increase was due to suppression of HIV, because HIV can damage mitochondria. However, only six months' worth of data were analysed. Long-term follow-up is needed to find out if there are differences between the two study groups. As well, it would have been interesting if researchers had presented data about changes (or not) in fat levels just under the skin (subcutaneous fat) as well as in the belly. Information on any damage to mitochondria in fat cells would have also been useful.
REFERENCE
Casula M, de Baar MP, van Gemen B, et al. Therapy with efavirenz+ritonavir-boosted indinavir, with or without stavudine after 24 weeks does not decrease mtDNA and mtRNA content of PBMC assessed by single tube duplex real-time NASBA. Abstract 25.
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