Recovering From Lipodystrophy After Stopping d4T in Children
Lipodystrophy is a side effect associated with some antiretroviral drugs that leads to atrophy and/or abnormal accumulations of fat in the body. The drug most associated with this side effect is stavudine, also known as d4T. Substituting other antiretroviral drugs for d4T can prevent worsening of the lipodystrophy and allow the body to recover.
Physicians in Chiang Mai, Thailand, have been carefully studying lipodystrophy in children at their pediatric HIV clinic since 2002. They first reported that 65 percent of their patients developed some form of lipodystrophy after 144 weeks of antiretroviral therapy.1 A recently published followup study monitoring 45 of these children showed that by 48 weeks after switching from d4T to zidovudine, 59 percent of children with fat atrophy and 40 percent of children with abnormal fat accumulation had recovered.2 However, 18 percent of the children still had lipodystrophy after 96 weeks.
Although the study cohort was small, this is the most closely monitored group of children with lipodystrophy described in published reports from Asia. It is encouraging that lipodystrophy in children can improve after switching from d4T to other drugs like zidovudine, abacavir, or tenofovir. The first step in this recovery is to get children off d4T. Currently, about 30 percent of children followed in the TREAT Asia Pediatric HIV Observational Database are still on d4T. Although in 2010, the World Health Organization recommended that d4T use be progressively reduced in adults, it did not recommend the same step for children. These research studies have demonstrated that Thai children can safely be switched from d4T and provide a model for the rest of the region to follow.
1. Aurpibul L, Puthanakit T, Lee B, Mangklabruks A, Sirisanthana T, Sirisanthana V. Lipodystrophy and metabolic changes in HIV-infected children on non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy. Antivir Ther. 2007;12(8):1247-54.
2. Aurpibul L, Puthanakit T, Taejaroenkul S, Sirisanthana T, Sirisanthana V. Recovery From Lipodystrophy in Human Immunodeficiency Virus-infected Children After Substitution of Stavudine With Zidovudine in a Non-nucleoside Reverse Transcriptase Inhibitor-based Antiretroviral Therapy. Pediatr Infect Dis J. 2011 Nov 23. [Epub ahead of print]