Lipodystrophy regresses in three patients switched to atazanavir

Graham McKerrow, HIV i-Base

Switching to atazanavir (ATV, Reyataz) 400 mg once a day from other PI-containing antiretroviral regimens resulted in decreases in total cholesterol and fasting triglyceride levels and in a regression of body fat accumulations in three patients in Germany, according to case reports outlined in a research letter published in 9 April issue of AIDS.

Georg Haerter and colleagues in Ulm and Stuttgart report that CD4 cell counts and viral responses were preserved with the ATV-containing regimens and they write: “We propose that in patients with lipodystrophy syndrome, switching to atazanavir from established PIs could lead to a reversal of the metabolic alterations and most notably to a rapid regression of pre-existing body fat accumulations.”

The three patients were included in the early access programme for ATV because they had elevated cholesterol and triglyceride levels. After switching, a reduction in fasting cholesterol, LDL-cholesterol and triglyceride levels was documented. In all patients the total bilirubin value increased under therapy with ATV but without clinical significance.

All three patients had a reduction in fat deposits, denoted in two patients by a reduction in their collar sizes and newly-recognised dents over the dorsocervical spine, and in the other patient by a reduction in waist size (American size 31 to 29). Body weight remained stable in all three patients.

The authors write that the clinical changes to the buffalo hump, with a reduction and a central dent over the spine and the reduced waist size were ‘obvious’, and that the constant body weights suggest that these changes were not due to modified diet or physical activities.

In all three patients, ATV was given unboosted, ie without a concomitant dose of 100 mg ritonavir.

The patients were:

Male, 37 years, started dual therapy in 1996, started a saquinavir-containing regimen in 2000, had a buffalo hump since July 2001, switched to ATV-containing regimen in April 2003.
Female, 45 years, treated with PI-containing regimens since 1996, eight changes to regimen since, suffered the loss of subcutaneous adipose tissue from the extremities and abdominal fat accumulation with a low-grade buffalo hump, started ATV-containing regimen in February 2003.
Male, 59, started PI-containing regimen September 1999, developed buffalo hump in 2001, switched to ATV April 2003.

Reference:

Haerter G, Manfras BJ, Mueller M et al. Regression of lipodystrophy in HIV-infected patients under therapy with the new protease inhibitor atazanavir. AIDS 18(6) 9 April 2004, 952-955.
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