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Decrease of subcutaneous adipose tissue in HIV patients after replacing established protease inhibitors with atazanavir
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Georg Härter1, Burkhard J. Manfras 1 , Trein Andreas 2 , Mueller Markus 3 , Pauls Sandra 4 , Kern Peter 1. 1Section of Infectious Diseases, Department of Internal Medicine, University Hospital and Medical Center, Ulm, Germany; 2Private Practice, Schwabstrasse 57-59, Stuttgart, Germany; 3Private Practice, Schwabstrasse 26, Stuttgart, Germany; 4Department of Diagnostic Radiology, University of Ulm, Ulm, Germany
Several side effects have been observed since the introduction of ART in HIV-infected patients. Protease inhibitors (PI) may cause a complex of metabolic abnormalties and body fat distributions (lipodystrophy syndrome). Recently, atazanavir (ATV), a new PI, was approved by the FDA and has shown fewer metabolic side effects.
Three patients were switched from protease inhibitor containing regimen to ATV 400 mg once daily in combination with NRTIs because of metabolic abnormalties. For volumetric measurement of adipose tissue magnetic resonance imaging (MRI) was performed.
Immunologic and viral response were preserved after changing antiretroviral therapy. Fasting triglyceride and cholesterol levels decreased during therapy with atazanavir. Remarkably, preexisting buffalo hump and waist size, respectively, were reduced. MRI yielded a 30% reduction of subcutaneous adipose tissue after switching to ATV.
Switching to ATV 400 mg once daily from other PI containing antiretroviral regimen resulted in decreases in total cholesterol and fasting triglycerides levels. Furthermore and most notably, regression of body fat accumulations were observed, confirmed by MRI. Switching from established protease inhibitors to ATV in patients with lipodystrophy syndrome could lead to a rapid regression of pre-existing body fat accumulations and offers a new option in patients with lipodystrophy syndrome. A prospective study for validation of these findings is needed and intended.
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