Lipodystrophy: d4T blamed again
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The nucleoside anti-HIV drug d4T (stavudine or Zerit)
has once again popped up as a prime suspect in factors associated with
lipodystrophy, the collection of drug side effects that cause body shape
change, fat accumulation, fat wasting, and high levels of fats in the
blood.
1,359 patients on HIV medication from the Swiss HIV Cohort Study - one
of the most intensively monitored group of HIV patients in the world -
were looked at for signs of lipodystrophy. 43 per cent had at least one
sign of 'lipo'. Almost equal numbers - three in 10 - had either fat wasting
in the face or limbs (lipoatropy), or fat accumulation, and one in six
had both. The patients had been on combination therapy for 2-3 years on
average.
When the patients' medical histories were looked at, the
only factors significantly associated with lipo were d4T use, older age,
or elevated lactate levels in the blood. The latter is often a sign of
damage to the mitochondria, the cell components that turn fat and carbohydrates
into energy.
Perhaps surprisingly, use of protease inhibitors was not associated with
signs of lipo; nor was use of the other nucleoside drugs (AZT, ddI, 3TC
and the like), the patients' sex or how ill they'd ever been.
The findings, however, are unlikely to settle arguments about the prime
cause of the body-morphing fat redistribution syndrome for once and all.
The study only looked at patients who had developed lipo signs by August
and September 1999, so later and more slowly developing lipodystrophy
would
One of the effects of lipodystrophy
have been missed. It also lumped together all fat redistribution,
whereas many doctors believe it is in fact several overlapping side-effects,
probably with multiple causes.
Another recent survey has discovered that the protease inhibitor drugs
also damage mitochondria in
the test tube.
