Treating fat loss: other treatment approaches

A relatively new class of anti-diabetes drugs, called thiazolidinediones or glitazones, has been tested as a treatment for lipodystrophy, and fat wasting in particular. The glitazones are insulin-sensitising agents which, in HIV-negative people, encourage the storage of fatty acids in peripheral fat tissue. Small, early studies suggested that the glitazones would have a positive effect on fat wasting in people taking antiretroviral therapy. 1 2 3 However, glitazones have proven mostly unsuccessful at reducing fat wasting associated with antiretroviral therapy. 4 5 6 7

Rosiglitazone did improve insulin sensitivity and liver function. Unfortunately, the most common side-effects seen among those taking rosiglitazone were elevated triglycerides and elevated cholesterol. 8 3

Recently, a dietary supplement called NucleomaxX has also been shown to be effective in restoring fat loss in patients taking AZT or d4T. NucleomaxX is an extract of sugar cane that can raise levels of uridine in the body, which may block the toxicity caused by NRTIs and allow fat cells to regenerate.

Two studies have shown some benefits of the supplement in patients with fat loss who were taking AZT or d4T. One demonstrated that patients taking NucleomaxX alongside an antiretroviral drug regimen containing AZT or d4T gained more subcutaneous fat than patients taking a placebo supplement. 9The second, open-label study showed an improvement in subcutaneous fat loss over the body, although this was not coupled with improvements in levels of mitochondrial DNA in fat tissue. 10Larger, longer-term studies of NucleomaxX are underway.

References

  1. Visnegarwala F et al. Inconsistent effects of lipid-lowering drugs in the management of HIV-associated dyslipidemias. Third International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, Athens, abstract 30, in Antiviral Therapy 6(suppl 4): 21-22, 2001a
  2. Gelato MC et al. Improved insulin sensitivity and body fat distribution in HIV-infected patients treated with rosiglitazone: a pilot study. Journal of Acquired Immune Deficiency Syndromes 31(2): 163-170, 2002
  3. Hadigan C et al. Effects of rosiglitazone on metabolic indices and fat in HIV lipodystrophy: a randomized controlled trial. Ann Intern Med 140: 786-794, 2004
  4. Calmy A et al. Leptin levels remain unchanged after pioglitazone treatment in HIV infected patients with lipodystrophy. 14th International AIDS Conference, Barcelona, abstract TuPeB4524, 2002
  5. Carr A et al. No effect of rosiglitazone for treatment of HIV-1 lipoatrophy: randomised, double-blind, placebo-controlled trial. Lancet 363: 429-438, 2004
  6. Moyle GJ et al. A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection. HIV Med 5(2):82-7, 2004
  7. Cavalcanti RB et al. A randomized, placebo-controlled trial of rosiglitazone for HIV-related lipoatrophy. J Infect Dis 195:1754-1761, 2007
  8. Sutinen J et al. Rosiglitazone in the treatment of HAART-associated lipodystrophy (HAL): a randomized, double-blind, placebo-controlled study. Ninth Conference on Retroviruses and Opportunistic Infections, Seattle, abstract LB13, 2002
  9. Sutinen J et al. Uridine supplementation increases subcutaneous fat in patients with HAART-associated lipodystrophy: a randomised placebo-controlled trial. Antivir Ther 10: L7, 2005
  10. McComsey G et al. Extensive investigations of mitochondrial DNA genome in treated HIV-infected subjects: beyond mitochondrial DNA depletion. J Acquir Immune Defic Syndr 39: 181-188, 2005
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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