Effects of a Uridine Supplement on HIV Infected Adults With Lipoatrophy

• Time to Safety Events (Signs/Symptoms or Laboratory Abnormalities) [ Time Frame: Through Week 48 ] [ Designated as safety issue: Yes ]
  Time to safety events (grade 3 [Severe] or 4 [life-threatening] sign/symptom or laboratory-based abnormality that is at least one grade higher than baseline) from study entry
• Number of Subjects Discontinuing Study Medication [ Time Frame: Through Week 48 ] [ Designated as safety issue: No ]
  Number of eligible subjects who discontinued study medication during the study period.
• Change in Limb Fat From Baseline (Week 24 - Baseline) [ Time Frame: Baseline and Week 24 ] [ Designated as safety issue: No ]
  Limb fat was measured at baseline and visit week 24 using dual-energy x-ray absorptiometry (DEXA), and change from baseline to week 24 (week 24 - baseline) was estimated for the treatment groups.
• HIV-1 RNA Level [ Time Frame: At Week 48 ] [ Designated as safety issue: No ]
• Change in CD4+ Count From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Fasting Lactate From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Fasting Glucose From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Fasting Total Cholesterol From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Fasting High-density Lipoprotein (HDL) Cholesterol From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Fasting Non-HDL Cholesterol From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Fasting Low-density Lipoprotein (LDL) Cholesterol From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Fasting Triglycerides From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Hemoglobin From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Leukocytes From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]
• Change in Creatine Kinase From Baseline (Week 48 - Baseline) [ Time Frame: Baseline and Week 48 ] [ Designated as safety issue: No ]

• Signs and symptoms, laboratory-based toxicity, and discontinuation rates of the regimens
• change in DEXA-measured limb fat from baseline to Week 24
• change in HIV RNA and CD4 count from baseline through Week 48
• change in level of venous lactate from baseline through Week 48
• change in level of fasting lipids from baseline through Week 48
• change in level of plasma F2 isoprostanes, PBMC MDA and common deletion mitochondrial DNA from baseline through Week 48
• change in level of fasting glucose and insulin from baseline through Week 48
• change in PBMC mitochondrial DNA from baseline through Week 48
• change in PBMC endogenous nucleoside pools from baseline through Week 48
• change in hemoglobin, leukocytes, and creatine kinase from baseline through Week 48

Lipoatrophy, the loss of body fat from particular areas of the body, is a common side effect of antiretroviral therapy (ART). The purpose of this study was to determine the effectiveness of uridine supplementation in treating HIV infected individuals on stable ART with lipoatrophy.

Lipoatrophy is a distressing long-term complication of ART and is associated with decreased quality of life, an increased risk of cardiovascular disease, and nonadherence to ART. The cause of lipoatrophy in HIV-infected individuals receiving ART is not completely understood. However, past research suggests that mitochondrial toxicity in subcutaneous adipose tissue caused by thymidine analogue nucleoside analogues may be responsible for the development of lipoatrophy.

Uridine is a nucleoside that has been shown to be an effective supplement in treating individuals with mitochondrial toxicity. NucleomaxX is a food supplement that consists of mitocnol, a sugar cane extract that has a high content of nucleosides, including uridine. The purpose of this study was to evaluate the effects of uridine supplementation in the form of NucleomaxX on limb fat in HIV-infected individuals receiving stable ART containing stavudine (d4T) or zidovudine (ZDV). In addition, this study evaluated the safety and tolerability of NucleomaxX.

This study lasted for 48 weeks. Participants were randomly assigned to one of two treatment arms, stratified by d4T or ZDV use. Arm A participants received NucleomaxX for uridine, while Arm B participants received a placebo for NucleomaxX. Participants in both arms received their assigned intervention three times per day, every other day, for the duration of the study. There were 8 study visits over the 48-week study duration. Blood collection and a physical exam occurred at all study visits, and participants completed an adherence assessment at most visits. Participants underwent dual energy X-ray absorptiometry scans (DEXA) within 14 days prior to or following the screening visit and at other selected visits. Specific fasting tests for glucose and lipid levels occurred at selected visits. ART was not provided by this study.

• HIV Infections
• Lipoatrophy

• Drug: NucleomaxX
  36 g sachet taken orally three times daily
• Drug: NucleomaxX placebo
  36 g placebo sachet taken orally three times daily

• Active Comparator: NucleomaxX
  Participants received NucleomaxX for 48 weeks
  Intervention: Drug: NucleomaxX
• Placebo Comparator: Placebo
  Participants received NucleomaxX placebo for 48 weeks
  Intervention: Drug: NucleomaxX placebo

• McComsey GA, Walker UA, Budhathoki CB, Su Z, Currier JS, Kosmiski L, Naini LG, Charles S, Medvik K, Aberg JA; on behalf of the AIDS Clinical Trials Group A5229 Team. Uridine supplementation in the treatment of HIV lipoatrophy: results of ACTG 5229. AIDS. 2010 Sep 7; [Epub ahead of print]
• Koch EC, Schneider J, Weis R, Penning B, Walker UA. Uridine excess does not interfere with the antiretroviral efficacy of nucleoside analogue reverse transcriptase inhibitors. Antivir Ther. 2003 Oct;8(5):485-7. No abstract available.
• McComsey GA, Walker UA. Role of mitochondria in HIV lipoatrophy: insight into pathogenesis and potential therapies. Mitochondrion. 2004 Jul;4(2-3):111-8.
• Nolan D, Hammond E, Martin A, Taylor L, Herrmann S, McKinnon E, Metcalf C, Latham B, Mallal S. Mitochondrial DNA depletion and morphologic changes in adipocytes associated with nucleoside reverse transcriptase inhibitor therapy. AIDS. 2003 Jun 13;17(9):1329-38.
• Walker UA, Venhoff N. Uridine in the prevention and treatment of NRTI-related mitochondrial toxicity. Antivir Ther. 2005;10 Suppl 2:M117-23. Review.

Inclusion Criteria:

• HIV-1 infected
• Stable ART containing zidovudine or stavudine for at least 12 consecutive weeks prior to study entry
• Cumulative ART with zidovudine or stavudine for at least 24 weeks prior to study entry
• Viral load of 5,000 copies/ml or less within 45 days prior to study entry
• Lipoatrophy in at least two of the following areas: face, arms, legs, OR buttocks
• Not planning to add to or change current vitamin supplementation
• Willing to use acceptable forms of contraception

Exclusion Criteria:

• Life expectancy of less than 12 months
• Currently enrolled in or planning to enroll in an ART interruption study
• Plans to change current ART regimen
• Liver failure at anytime prior to study entry
• Greater than Grade 2 diarrhea or vomiting within 7 days prior to study entry
• Current AIDS-defining opportunistic infection or illness. Individuals with cutaneous Kaposi's sarcoma not requiring chemotherapy are not excluded.
• Currently receiving insulin or oral hypoglycemic products for diabetes mellitus
• Systemic cancer chemotherapy or immunomodulating agents within 30 days prior to study entry
• Systemic steroids for a cumulative duration of longer than 4 weeks within the 6 months prior to study entry
• Known allergy or sensitivity to study drug or any of its components
• Severe lactose intolerance
• Current drug or alcohol abuse or dependence
• Clinically significant illness requiring systemic treatment or hospitalization
• Chronic disability or serious illness that may affect body composition
• Received an investigational drug other than NucleomaxX or uridine for lipoatrophy within 30 days prior to study entry
• Certain abnormal laboratory values
• Pregnancy or breastfeeding