HIV Acquired Lipodystrophy (HAL) Classification, Measurement and Fat Response to Thiazolidinedione (TZD) (Pioglitazone)

Study Overview
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Brief Summary
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This study is being done to better understand why people with HIV who have taken drugs for HIV begin to show abnormal changes in fat loss or fat gain in their bodies. This condition is called lipodystrophy. Patients who take medicine for HIV and who have lipodystrophy report loss of subcutaneous (sc) fat from the arms, legs, and face and excess fat gain in the neck and truncal region. They also more likely to have problems with insulin in the body, high fat levels in the blood and diabetes. The reason that lipodystrophy develops is not fully understood although some HIV drugs have are very likely the cause. The complications pose an increased risk of fat blockage forming in the arteries making you more at risk for heart problems in the future. Changes in body fat can cause physical discomfort and psychological distress. Management of these problems can be a challenge for the patient's doctor. The investigators propose data collection to determine if there is more than one reason why this might happen in some people and not in others. Laboratory samples being collected: 1) special imaging of the liver; 2) fat collected by needle from the mid thigh and mid-shoulder areas; 3) blood samples to measure the virus, t-cells, fats, and other markers of how the patient's body is handling the virus. This study is being done because science does not fully understand why some patients with HIV who take medicines for the virus have abnormal fat loss or gain and some do not. This research study is intended to help us better understand why and how this happens.

Official Title
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Human Immunodeficiency Virus Acquired Lipodystrophy (HAL) Classification, Measurement, & Fat Response to a Thiazolidinedione (TZD) Challenge in Differing Adult Phenotypic Presentations

Conditions
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HIV Infections

Intervention / Treatment
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* Drug: Pioglitazone
* Other: Observation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Participants must be 18 years of age or older of all racial and ethnic origins, and capable of giving informed consent. Spanish speaking individuals are eligible for participation. Additionally they must be/have: Biologically male (not transgendered) HIV positive for at least 24 months, On stable HAART for at least the last 3 months prior to entering the study, Practitioner diagnosed lipodystrophy as defined by: aHAL (any of these) decreased subcutaneous fat in the limbs with prominent veins, loss of buttock fat or facial atrophy hHAL: fat accumulation in abdomen and/or dorsocervical region Exclusion Criteria: Participants cannot be less than 18 years of age, institutionalized, nor have prior diseases or conditions that may alter body fat composition. Exclusions: Females are excluded Prior history of CHF Prior history of macular retinal edema Prior history of spontaneous bone fracture Diabetics receiving oral/injected/inhaled diabetic agents or individuals with a fasting blood glucose value greater than or equal to 140 within the last 90 days. Current active opportunistic infections for example : PCP pneumonia Neuropathy Thrush Systemic KS (Kaposi sarcoma) i) localized cutaneous lesions are not an exclusion e) MAC (Mycobacterium Avium complex) f) Histoplasmosis g) Coccidioidomycosis Planning to discontinue HAART Current diagnosis of cancer or receiving chemotherapy Systemic steroid use during the prior 6 months Hepatitis C+ or previous diagnosis of cirrhosis Liver Function Studies great than or equal to triple of normal values

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Pioglitazone<br>10 male patients with lipodystrophy taking daily Pioglitazone 45 mg | Drug: Pioglitazone<br>* Participants will take oral Pioglitazone 45 mg daily for 16 weeks.<br>* Other names: Actos;|
| Sham Comparator: Observation/Comparison<br>10 male patients with lipodystrophy not taking daily Pioglitazone | Other: Observation<br>* Participants will be observed for 16 weeks but will not receive drug<br>* Other names: Comparison;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent of Liver Fat Pre/Post Challenge With Daily Pioglitazone 45 mg | No data are available for this study as the PI has left the institution. Multiple efforts to contact the PI for the relevant data have failed | 16 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fine Needle Aspiration of Fat Pre/Post With Daily Pioglitazone 45 mg |  | 16 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HIV, Lipodystrophy, Lipoatrophy, Lipohypertrophy, Human Immunodeficiency Virus