I guess it's Oficial: Drug Switch May Reduce HIV-Related Lipoatrophy

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People with HIV who develop treatment-related loss of fat in the arms and the face may have antiretroviral options that might minimize ongoing fat loss, according to several studies presented here at the 12th Conference on Retroviruses and Opportunistic Infections. Lipoatrophy is a common adverse effect of antiretroviral therapy, in particular the thymidine analog nucleoside reverse transcriptase inhibitors (NRTI) stavudine (d4T) and zidovudine (AZT). The drug abacavir is commonly used as an alternative. However, a team led by a U.K. collaborative study group and chaired by Graeme Moyle, MD, from the Chelsea and Westminster Hospital in the U.K., found that lipoatrophic HIV-infected adults who switched from an NRTI to abacavir or tenofovir DF for 48 weeks saw significant increases in limb fat.

The study randomly assigned 105 patients with moderate to severe lipoatrophy to switch to one of the nonthymidine NRTIs. Both groups saw a similar increase in limb fat from baseline and the drugs were equally effective for virus suppression. Patients were more likely to stay on tenofovir than abacavir, the study found. In addition, the patients receiving tenofovir had significant improvements in total cholesterol, triglyceride, and high-density lipoprotein cholesterol levels, the study found.

"Our study indicates that switching a thymidine analog to tenofovir represents a new treatment option for people with lipoatrophy which is as effective at allowing fat recovery as the established standard of switch to abacavir," Dr. Moyle said after the presentation. "In addition, tenofovir had improved tolerability and leads to significantly better lipid outcomes than the switch to abacavir."

Another study found that patients with lipoatrophy could benefit if they switch to NRTI-sparing regimens containing protease inhibitors. A study of 62 subjects found that those who switched to a regimen of ritonavir-boosted lopinavir plus efavirenz gained 526 g of fat in the arms compared with a loss of 246 g for those in the NRTI-containing group. The switch had no effect on glucose metabolism or bone mineral density. Pablo Tebas, MD, from the University of Pennsylvania in Philadelphia, led the study, which was conducted by researchers in the Adult AIDS Clinical Trial Group (ACTG).

A study by researchers from Northwestern University in Chicago, Illinois, offered another option for lipoatrophic HIV-infected patients. The researchers randomized 101 patients receiving ZDV or d4T to one of three groups. Twenty-four patients stayed on their current drug regimen for 24 weeks, and 77 patients switched to abacavir or to an NRTI-sparing regimen of lopinavir/ritonavir plus nevirapine. , MD, led this multisite ACTG study.

The switch to either drug resulted in improvements in thigh and abdominal fat without any loss of virologic control.

"What these studies show us pretty consistently is that tenofovir, abacavir, or the absence of any nucleoside allows the body to restore limb fat," said Calvin J. Cohen, MD, research director of Harvard Vanguard Medical Associates and a clinical instructor at Harvard Medical School in Boston, Massachusetts. "That message is consistent with all of these."

What researchers need to do now is look at the pros and cons of each approach and figure out whether they can do better, Dr. Cohen said. Each time they switch treatments, he said, physicians and patients need to ask, if we make this a little better what do we make worse?

"So that trade off will be a research agenda for the next few years in this very important field," Dr. Cohen concluded.

12th CROI: Abstracts 40, 44LB, and 45LB. Presented Feb. 23, 2005.

The hottest places in hell are reserved for those who, in times of great crisis, do nothing. - Dante This information is not to replace the advice of a physician or other health care professionals. Anyone intending on any dietary, drug or exercise changes to prevent or treat a specific disease or condition ought to consult with a health care professional.