Effects of a Uridine Supplement on HIV Infected Adults 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.

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