ART and lipoatrophy

 Q: Which class of antiretroviral therapy (ART) in HIV patients is more associated with lipoatrophy?

Answer: Nucleoside reverse transcriptase inhibitors (NRTIs) 

 NRTIs are found to be a major culprit associated with lipoatrophy in HIV patients undergoing ART. The thymidine analog, stavudine is found to be most notorious, though zidovudine can do the same. The duration of treatment is directly proportional to the development of lipoatrophy. The thymidine analogs induce inhibition of mitochondrial DNA polymerase gamma and cause mitochondrial toxicity. A biopsy demonstrates mitochondrial DNA depletion, inflammation, and signs of apoptosis.

This side effect has put these ART out of favor for regular use in HIV patients.

#pharmacology

#infectious-diseases

References:

1. Joly V, Flandre P, Meiffredy V, et al. Increased risk of lipoatrophy under stavudine in HIV-1-infected patients: results of a substudy from a comparative trial. AIDS 2002; 16:2447. 

2.  Shlay JC, Sharma S, Peng G, et al. Long-term subcutaneous tissue changes among antiretroviral-naive persons initiating stavudine, zidovudine, or abacavir with lamivudine. J Acquir Immune Defic Syndr 2008; 48:53. 

3.  Shlay JC, Sharma S, Peng G, et al. The effect of individual antiretroviral drugs on body composition in HIV-infected persons initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2009; 51:298.