Cardiovascular risk and body-fat abnormalities in HIV-infected adults

New England Journal of Medicine

Volumn 352, Issue 1, 2005, Pages 48-62

  Grinspoon, Steven ^a   Carr, Andrew ^b  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b ST VINCENT S HOSPITAL   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

ALPHA INTERFERON; AMPRENAVIR; ANTIVIRUS AGENT; APOLIPOPROTEIN C3; APOLIPOPROTEIN E; ATAZANAVIR; ATORVASTATIN; BEZAFIBRATE; DIDANOSINE; FENOFIBRATE; FIBRIC ACID DERIVATIVE; GEMFIBROZIL; GLUCOSE TRANSPORTER 4; HIGH DENSITY LIPOPROTEIN CHOLESTEROL; INDINAVIR; LAMIVUDINE PLUS ZIDOVUDINE; LOPINAVIR; LOW DENSITY LIPOPROTEIN CHOLESTEROL; NELFINAVIR; NUCLEOSIDE ANALOG; PRAVASTATIN; PROTEINASE INHIBITOR; RITONAVIR; RNA DIRECTED DNA POLYMERASE INHIBITOR; SAQUINAVIR; STATIN; STAVUDINE; STEROL REGULATORY ELEMENT BINDING PROTEIN 1; TRIACYLGLYCEROL; UNINDEXED DRUG;

ADIPOCYTE; BODY FAT; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RISK; CHOLESTEROL BLOOD LEVEL; DIABETES MELLITUS; DYSLIPIDEMIA; GLUCOSE BLOOD LEVEL; GLUCOSE HOMEOSTASIS; GLUCOSE TOLERANCE; GLUCOSE TRANSPORT; HIGHLY ACTIVE ANTIRETROVIRAL THERAPY; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; HYPERCHOLESTEROLEMIA; HYPERINSULINEMIA; HYPERLIPIDEMIA; HYPERTRIGLYCERIDEMIA; INSULIN RELEASE; INSULIN RESISTANCE; INSULIN SENSITIVITY; LIFESTYLE; LIPID METABOLISM; LIPOATROPHY; LIPOGENESIS; LIPOPROTEIN BLOOD LEVEL; METABOLIC DISORDER; PANCREAS ISLET BETA CELL; PREVALENCE; PRIORITY JOURNAL; REVIEW; TREATMENT OUTCOME; TRIACYLGLYCEROL BLOOD LEVEL;

ANTI-RETROVIRAL AGENTS; ANTILIPEMIC AGENTS; ANTIRETROVIRAL THERAPY, HIGHLY ACTIVE; BODY COMPOSITION; CARDIOVASCULAR DISEASES; HIV INFECTIONS; HIV-ASSOCIATED LIPODYSTROPHY SYNDROME; HUMANS; HYPERLIPIDEMIAS; HYPOGLYCEMIC AGENTS; INSULIN RESISTANCE; RISK ASSESSMENT; RISK FACTORS;

EID: 11344293751     PISSN: 00284793     EISSN: None     Source Type: Journal    
DOI: 10.1056/NEJMra041811     Document Type: Review

References (99)

1. Lichtenstein KA, Ward DJ, Moorman AC, et al. Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS 2001;15:1389-98.
2. Bernasconi E, Boubaker K, Junghans C, et al. Abnormalities of body fat distribution in HIV-infected persons treated with andretroviral drugs: the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2002;31:50-5.
3. Miller J, Carr A, Emery S, et al. HIV lipodystrophy: prevalence, severity and correlates of risk in Australia. HIV Med 2003;4:293-301.
4. Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 1999;353:2093-9.
5. Gervasoni C, Ridolfo AL, Trifiro G, et al. Redistribution of body fat in HIV-infected women undergoing combined antiretroviral therapy. AIDS 1999;13:465-71.
6. Grunfeld C. Basic science and metabolic disturbances. In: Program and abstracts of the XIV International AIDS Conference, Barcelona, Spain, July 7-12, 2002:81. abstract.
7. Carr A, Emery S, Law M, Puls R, Lundgren JD, Powderly WG. An objective case definition of lipodystrophy in HIV-infected adults: a case-control study. Lancet 2003;361:726-35.
8. Carr A, Cooper DA. Lipodystrophy associated with an HIV-protease inhibitor. N Engl J Med 1998;339:1296.
9. Mallon PW, Miller J, Cooper DA, Carr A. Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1-infected men starting therapy. AIDS 2003;17:971-9.
10. Dube M, Zackin R, Tebas P, et al. Prospective study of regional body composition in antiretroviral-naive subjects randomized to receive zidovudine+lamivudine or didanosine+stavudine combined with nelfinavir, efavirenz, or both: A5005s, a study of ACTG 384. Antivir Ther 2002:L18.
11. Martinez E, Mocroft A, Garcia-Viejo MA, et al. Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study. Lancet 2001;357:592-8.
12. Heath KV, Hogg RS, Singer J, Chan KJ, O'Shaughnessy MV, Montaner JS. Antiretroviral treatment patterns and incident HIV-associated morphologic and lipid abnormalities in a population-based cohort. J Acquir Immune Defic Syndr 2002;30:440-7.
13. Bastard JP, Caron M, Vidal H, et al. Association between altered expression of adipogenic factor SREBP1 in lipoatrophic adipose tissue from HIV-1-infected patients and abnormal adipocyte differentiation and insulin resistance. Lancet 2002;359:1026-31.
14. Caron M, Auclair M, Vigouroux C, Glorian M, Forest C, Capeau J. The HIV protease inhibitor indinavir impairs sterol regulatory element-binding protein-1 intranuclear localization, inhibits preadipocyte differentiation, and induces insulin resistance. Diabetes 2001;50:1378-88.
15. Dowell P, Flexner C, Kwiterovich PO, Lane MD. Suppression of preadipocyte differentiation and promotion of adipocyte death by HIV protease inhibitors. J Biol Chem 2000;275:41325-32.
16. Lenhard JM, Furfine ES, Jain RG, et al. HIV protease inhibitors block adipogenesis and increase lipolysis in vitro. Antiviral Res 2000;47:121-9.
17. Caron M, Auclair M, Sterlingot H, Kornprobst M, Capeau J. Some HIV protease inhibitors alter lamin A/C maturation and stability, SREBP-1 nuclear localization and adipoqte differentiation. AIDS 2003;17:2437-44.
18. Reiss P, Casula M, de Ronde A, Weverling G, Goudsmit J, Lange JM. Greater and more rapid depletion of mitochondrial DNA in blood of patients treated with dual (zidovudine+didanosine or zidovudine+ zalcitabine) vs. single (zidovudine) nucleoside reverse transcriptase inhibitors. HIV Med 2004;5:11-4.
19. Nolan D, Hammond E, Martin A, et al. Mitochondrial DNA depletion and morphologic changes in adipocytes associated with nucleoside reverse transcriptase inhibitor therapy. AIDS 2003;17:1329-38.
20. Pace CS, Martin AM, Hammond EL, Mamotte CD, Nolan DA, Mallal SA. Mitochondrial proliferation, DNA depletion and adipocyte differentiation in subcutaneous adipose tissue of HIV-positive HAART recipients. Antivir Ther 2003;8:323-31.
21. Hadigan C, Borgonha s, Rabe J, Young V, Grinspoon S. Increased rates of lipolysis among human immunodeficiency virus-infected men receiving highly active antiretroviral therapy. Metabolism 2002;51:1143-7.
22. Roche R, Poizot-Martin I, Yazidi CM, et al. Effects of antiretroviral drug combinations on the differentiation of adipocytes. AIDS 2002;16:13-20.
23. Galli M, Veglia F, Angarano G, et al. Gender differences in antiretroviral drug-related adipose tissue alterations: women are at higher risk than men and develop particular lipodystrophy patterns. J Acquir Immune Defic Syndr 2003;34:58-61.
24. Sutinen J, Hakkinen AM, Westerbacka J, et al. Increased fat accumulation in the liver in HIV-infected patients with antiretroviral therapy-associated lipodystrophy. AIDS 2002;16:2183-93.
25. Gan SK, Samaras K, Thompson CH, et al. Altered myocellular and abdominal fat partitioning predict disturbance in insulin action in HIV protease inhibitor-related lipodystrophy. Diabetes 2002;51:3163-9.
26. Behrens GM, Boerner AR, Weber K, et al. Impaired glucose phosphorylation and transport in skeletal muscle cause insulin resistance in HIV-1-infected patients with lipodystrophy. J Clin Invest 2002;110:1319-27.
27. Martin A, Smith DE, Carr A, et al. Reversibility of lipoatrophy in HIV-infected patients 2 years after switching from a thymidine analogue to abacavir: the MITOX Extension Study. AIDS 2004;18:1029-36.
28. Hadigan C, Meigs JB, Corcoran C, et al. Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis 2001;32:130-9.
29. Friis-Møller N, Weber R, Reiss P, et al. Cardiovascular disease risk factors in HIV patients - association with andretroviral therapy: results from the DAD study. AIDS 2003;17:1179-93.
30. Riddler SA, Smit E, Cole SR, et al. Impact of HIV infection and HAART on serum lipids in men. JAMA 2003;289:2978-82.
31. Grunfeld C, Pang M, Doerrler W, Shigenaga JK, Jensen P, Feingold KR. Lipids, lipoproteins, triglyceride clearance, and cytokines in human immunodeficiency virus infection and the acquired immunodeficiency syndrome. J Clin Endocrinol Metab 1992; 74:1045-52.
32. Hellerstein MK, Grunfeld C, Wu K, et al. Increased de novo hepatic lipogenesis in human immunodeficiency virus infection. J Clin Endocrinol Metab 1993;76:559-65.
33. Grunfeld C, Doerrler W, Pang M, Jensen P, Weisgraber KH, Feingold KR. Abnormalities of apolipoprotein E in the acquired immunodeficiency syndrome. J Clin Endocrinol Metab 1997;82:3734-40.
34. Christeff N, Melchior JC, de Truchis P, Perronne C, Gougeon ML. Increased serum interferon alpha in HIV-1 associated lipodystrophy syndrome. Eur J Clin Invest 2002;32:43-50.
35. Matthews GV, Moyle GJ, Mandalia S, Bower M, Nelson M, Gazzard BG. Absence of association between individual thymidine analogues or nonnucleoside analogues and lipid abnormalities in HIV-1-infected persons on initial therapy. J Acquir Immune Defic Syndr 2000;24:310-5.
36. Gallant JE, Staszewski S, Pozniak AL, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA 2004;292:191-201.
37. van der Valk M, Kastelein JJ, Murphy RL, et al. Nevirapine-containing antiretroviral therapy in HIV-1 infected patients results in an anti-atherogenic lipid profile. AIDS 2001;15:2407-14.
38. Lenhard JM, Croom DK, Weiel JE, Winegar DA. HIV protease inhibitors stimulate hepatic triglyceride synthesis. Arterioscler Thromb Vasc Biol 2000;20:2625-9.
39. Murphy RL, Sanne I, Cahn P, et al. Dose-ranging, randomized, clinical trial of atazanavir with lamivudine and stavudine in antiretroviral-naive subjects: 48-week results. AIDS 2003;17:2603-14.
40. Periard D, Telenti A, Sudre P, et al. Atherogenic dyslipidemia in HIV-infected individuals treated with protease inhibitors: the Swiss HIV Cohort Study. Circulation 1999;100:700-5.
41. Schmitz M, Michl GM, Walli R, et al. Alterations of apolipoprotein B metabolism in HIV-infected patients with antirerroviral combination therapy. J Acquir Immune Defic Syndr 2001;26:225-35.
42. Liang JS, Distler O, Cooper DA, et al. HIV protease inhibitors protect apolipoprotein B from degradation by the proteasome: a potential mechanism for protease inhibitor-induced hyperlipidemia. Nat Med 2001;7:1327-31.
43. Bonnet E, Ruidavets JB, Tuech J, et al. Apoprotein c-III and E-containing lipoparticles are markedly increased in HIV-infected patients treated with protease inhibitors: association with the development of lipodystrophy. J Clin Endocrinol Metab 2001;86:296-302.
44. Brown TT, Cole SR, Li X, et al. Prevalence and incidence of pre-diabetes and diabetes in the Multicenter AIDS Cohort Study. In: Proceedings of the 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, February 8-11, 2004:73. abstract.
45. Tong Q, Sankale JL, Hadigan CM, et al. Regulation of adiponectin in human immunodeficiency virus-infected patients: relationship to body composition and metabolic indices. J Clin Endocrinol Metab 2003;88:1559-64.
46. Murata H, Hruz PW, Mueckler M. The mechanism of insulin resistance caused by HIV protease inhibitor therapy. J Biol Chem 2000;275:20251-4.
47. Rudich A, Vanounou S, Riesenberg K, et al. The HIV protease inhibitor nelfinavir induces insulin resistance and increases basal lipolysis in 3T3-L1 adipocytes. Diabetes 2001;50:1425-31.
48. Ben-Romano R, Rudich A, Torok D, et al. Agent and cell-type specificity in the induction of insulin resistance by HIV protease inhibitors. AIDS 2003;17:23-32.
49. Noor MA, Seneviratne T, Aweeka FT, et al. Indinavir acutely inhibits insulin-stimulated glucose disposal in humans: a randomized, placebo-controlled study. AIDS 2002;16:F1-F8.
50. Lee GA, Seneviratne T, Noor MA, et al. The metabolic effects of lopinavir/ritonavir in HIV-negative men. AIDS 2004;18:641-9.
51. Noor MA, Grasela D, Parker RA, et al. The effect of atazanavir vs lopinavir/ritonavir on insulin-stimulated glucose disposal rate in healthy subjects. In: Proceedings of the 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, February 8-11, 2004:702. abstract
52. Kurowski M, Sternfeld T, Sawyer A, Hill A, Mocklinghoff C. Pharmacokinetic and tolerability profile of twice-daily saquinavir hard gelatin capsules and saquinavir soft gelatin capsules boosted with ritonavir in healthy volunteers. HIV Med 2003;4:94-100.
53. Woerle HJ, Mariuz PR, Meyer C, et al. Mechanisms for the deterioration in glucose tolerance associated with HIV protease inhibitor regimens. Diabetes 2003;52:918-25.
54. Bozzette SA, Ake CF, Tam HK, Chang SW, Louis TA. Cardiovascular and cerebrovascular events in patients treated for human immunodeficiency virus infection. N Engl J Med 2003;348:702-10.
55. Klein D, Hurley LB, Quesenberry CP Jr, Sidney S. Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? J Acquir Immune Defic Syndr 2002;30:471-7.
56. Mary-Krause M, Cotte L, Simon A, Partisani M, Costagliola D. Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men. AIDS 2003;17:2479-86.
57. Currier JS, Taylor A, Boyd F, et al. Coronary heart disease in HIV-infected individuals. J Acquir Immune Defic Syndr 2003;33:506-12.
58. The Data Collection on Adverse Events of Anti-HIV Drugs (DAD) Study Group. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med 2003;349:1993-2003. [Erratum, N Engl J Med 2004;350:955.]
59. d'Arminio A, Sabin CA, Phillips AN, et al. Cardio- and cerebrovascular events in HIV-infected persons. AIDS 2004;18:1811-7.
60. Law MG, D'Arminio Monforte A, Friis-Moller N, et al. Cardio- and cerebrovascular events and predicted rates of myocardial infarction in the D:A:D: study. In: Proceedings of the 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, February 8-11, 2004:737. abstract.
61. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837-47.
62. Stein JH, Klein MA, Bellehumeur JL, et al. Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation 2001;104:257-62.
63. Hsue PY, Lo JC, Franklin A, et al. Progression of atherosclerosis as assessed by carotid intima-media thickness in patients with HIV infection. Circulation 2004;109:1603-8.
64. Koppel K, Bratt G, Schulman S, Bylund H, Sandstrom E. Hypofibrinolytic state in HIV-1-infected patients treated with protease inhibitor-containing highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2002;29:441-9.
65. Dressman J, Kincer J, Matveev SV, et al. HIV protease inhibitors promote atherosclerotic lesion formation independent of dyslipidemia by increasing CD36-dependent cholesteryl ester accumulation in macrophages. J Clin Invest 2003;111:389-97.
66. Henry K, Melroe H, Huebesch J, Hermundson J, Simpson J. Atorvastatin and gemfibrozil for protease-inhibitor-related lipid abnormalities. Lancet 1998;352:1031-2.
67. Miller J, Brown D, Amin J, et al. A randomized, double-blind study of gemfibrozil for the treatment of protease inhibitor-associated hypertriglyceridaemia. AIDS 2002;16:2195-200.
68. Moyle GJ, Lloyd M, Reynolds B, Baldwin C, Mandalia S, Gazzard BG. Dietary advice with or without pravastatin for the management of hypercholesterolaemia associated with protease inhibitor therapy. AIDS 2001;15:1503-8.
69. Calza L, Manfredi R, Chiodo F. Statins and fibrates for the treatment of hyperlipidaemia in HIV-infected patients receiving HAART. AIDS 2003;17:851-9.
70. Martínez E, Arnaiz JA, Podzamczer D, et al. Substitution of nevirapine, efavirenz, or abacavir for protease inhibitors in patients with human immunodeficiency virus infection. N Engl J Med 2003;349:1036-46.
71. Martinez E, Conget I, Lozano L, Casamitjana R, Gatell JM. Reversion of metabolic abnormalities after switching from HIV-1 protease inhibitors to nevirapine. AIDS 1999;13:805-10.
72. Barreiro P, Soriano V, Blanco F, Casimiro C, de la Cruz JJ, Gonzalez-Lahoz J. Risks and benefits of replacing, protease inhibitors by nevirapine in HIV-infected subjects under long-term successful triple combination therapy. AIDS 2000;14:807-12.
73. Roubenoff R, Schmitz H, Bairos L, et al. Reduction of abdominal obesity in lipodystrophy associated with human immunodeficiency virus infection by means of diet and exercise: case report and proof of principle. Clin Infect Dis 2002;34:390-3.
74. Jones SP, Doran DA, Leatt PB, Maher B, Pirmohamed M. Short-term exercise training improves body composition and hyperlipidaemia in HIV-positive individuals with lipodystrophy. AIDS 2001;15:2049-51.
75. Thoni GJ, Fedou C, Brun JF, et al. Reduction of fat accumulation and lipid disorders by individualized light aerobic training in human immunodeficiency virus infected patients with lipodystrophy and/or dyslipidemia. Diabetes Metab 2002;28:397-404.
76. Driscoll SD, Meininger GE, Lareau MT, et al. Effects of exercise training and metformin on body composition and cardiovascular indices in HIV-infected patients. AIDS 2004;18:465-73.
77. Driscoll SD, Meininger GE, Ljungquist K, et al. Differential effects of metformin and exercise on muscle adiposity and metabolic indices in human immunodeficiency virus-infected patients. J Clin Endocrinol Metab 2004;89:2171-8.
78. Barrios A, Blanco F, Garcia-Benayas T, et al. Effect of dietary intervention on highly active antiretroviral therapy-related dyslipemia. AIDS 2002;16:2079-81.
79. Badiou S, Merle De Boever C, Dupuy AM, Baillat V, Cristol JP, Reynes J. Fenofibrate improves the atherogenic lipid profile and enhances LDL resistance to oxidation in HIV-positive adults. Atherosclerosis 2004;172:273-9.
80. Fichtenbaum CJ, Gerber JG, Rosenkranz SL, et al. Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG Study A5047. AIDS 2002;16:569-77.
81. Hadigan C, Meigs JB, Rabe J, et al. Increased PAI-1 and tPA antigen levels are reduced with metformin therapy in HIV-infected patients with fat redistribution and insulin resistance. J Clin Endocrinol Metab 2001;86:939-43.
82. Hadigan C, Corcoran C, Basgoz N, Davis B, Sax P, Grinspoon S. Metformin in the treatment of HIV lipodys trophy syndrome: a randomized controlled trial. JAMA 2000;284:472-7.
83. Hadigan C, Rabe J, Grinspoon S. Sustained benefits of metformin therapy on markers of cardiovascular risk in human immunodeficiency virus-infected patients with fat redistribution and insulin resistance. J Clin Endocrinol Metab 2002;87:4611-5.
84. Saint-Marc T, Touraine JL. Effects of metformin on insulin resistance and central adiposity in patients receiving effective protease inhibitor therapy. AIDS 1999;13:1000-2.
85. Martinez E, Domingo P, Ribera E, et al. Effects of metformin or gemfibrozil on the lipodystrophy of HIV-infected patients receiving protease inhibitors. Antivir Ther 2003;8:403-10.
86. Arioglu E, Duncan-Morin J, Sebring N, et al. Efficacy and safety of troglitazone in the treatment of lipodystrophy syndromes. Ann Intern Med 2000;133:263-74.
87. Sutinen J, Hakkinen AM, Westerbacka J, et al. Rosiglitazone in the treatment of HAART-associated lipodystrophy - a randomized double-blind placebo-controlled study. Antivir Ther 2003;8:199-207.
88. Hadigan C, Yawetz S, Thomas A, Havers F, Sax PE, Grinspoon S. Metabolic effects of rosiglitazone in HIV lipodystrophy: a randomized, controlled trial. Ann Intern Med 2004;140:786-94.
89. Carr A, Workman C, Carey D, et al. No effect of rosiglitazone for treatment of HIV-1 lipoatrophy: randomised, double-blind, placebo-controlled trial. Lancet 2004;363:429-38.
90. Calmy A, Hirschel B, Hans D, Karsegard VL, Meier CA. Glitazones in lipodystrophy syndrome induced by highly active antiretroviral therapy. AIDS 2003;17:770-2.
91. Gelato MC, Mynarcik DC, Quick JL, et al. Improved insulin sensitivity and body fat distribution in HIV-infected patients treated with rosiglitazone: a pilot study. J Acquir Immune Defic Syndr 2002;31:163-70.
92. Engelson ES, Glesby MJ, Mendez D, et al. Effect of recombinant human growth hormone in the treatment of visceral fat accumulation in HIV infection. J Acquir Immune Defic Syndr 2002;30:379-91.
93. Kotler DP, Muurahainen N, Grunfeld C, et al. Effects of growth hormone on abnormal visceral adipose tissue accumulation and dyslipidemia in HIV-infected patients. J Acquir Immune Defic Syndr 2004;35:239-52.
94. Koutkia P, Canavan B, Breu J, Torriani M, Kissko J, Grinspoon S. Growth hormone-releasing hormone in HIV-infected men with lipodystrophy: a randomized, controlled trial. JAMA 2004;292:210-8.
95. Moyle GJ, Lysakora L, Brown S, 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 2004;5:82-7.
96. John M, McKinnon EJ, James IR, et al. Randomized, controlled, 48-week study of switching stavudine and/or protease inhibitors to combivir/abacavir to prevent or reverse lipoatrophy in HIV-infected patients. J Acquir Immune Defic Syndr 2003;33:29-33.
97. Moyle GJ, Baldwin C, Langroudi B, Mandalia S, Gazzard BG. A 48-week, randomized, open-label comparison of three abacavir-based substitution approaches in the management of dyslipidemia and peripheral lipoatrophy. J Acquit Immune Defic Syndr 2003;33:22-8.
98. Negredo E, Ribalta J, Paredes R, et al. Reversal of atherogenic lipoprotein profile in HIV-1 infected patients with lipodystrophy after replacing protease inhibitors by nevirapine. AIDS 2002;16:1383-9.
99. Shlay J, Visnegarwala F, Bartsch GE, et al. Rates of change in body composition among antiretroviral naive HIV-infected patients randomized to a didanosine/stavudine versus abacavir/lamivudine containing regimen in the Flexible Initial Retrovirus Suppressive Therapies (FIRST) Study, CPCRA 058. Antivir Ther 2003;8:L12. abstract.