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Sponsorship: The Takeda company provided pioglitazone, as well as partial funding for the laboratory and DEXA measurements. Received: 15 August 2002; revised: 20 September 2002; accepted: 7 October 2002. Anti-diabetic glitazones are known to alter fat distribution in non-HIV lipodystrophy. We therefore assessed the safety and preliminary efficacy of treatment with pioglitazone for 6 months in 11 patients with lipodystrophy related belly fat to highly active belly fat antiretroviral therapy (HAART). No serious side-effects were observed. Body belly fat fat mass (total and leg) increased significantly, whereas no changes were found in the lipid profile. The good tolerance and fat redistribution observed with pioglitazone warrants a larger randomized trial in patients with HAART-related lipodystrophy. Lipodystrophy syndrome is a major problem for the long-term use of highly active antiretroviral therapy (HAART) in HIV-positive patients [1]. No single treatment has been validated to date [2], and the management of this disorder is essentially empiric: the avoidance of protease inhibitors [3] and stavudine [4] in the regimen, treatment of metabolic disturbances, although surgery is often the only way of reversing atrophy of the face or a prominent buffalo hump [5].
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