Lipoatrophy Literature: Commentary by Dr. John G. Bartlett -- April 2007
Lipoatrophy Literature: Commentary by Dr. John G. Bartlett -- April 2007
Moyle GJ, Sabin CA, Cartledge J, et al; for the RAVE (Randomized Abacavir versus Viread Evaluation) Group UK. A randomized comparative trial of tenofovir DF or abacavir as replacement for a thymidine analogue in persons with lipoatrophy. AIDS. 2006;20:2043-2050. The goal of the study was to determine the relative merit of abacavir (ABC) vs tenofovir (TDF) as replacement for thymidine analogues in patients with lipoatrophy.
Methods: This was a randomized, open-label trial involving the switch from zidovudine or stavudine (d4T) to either TDF or ABC among patients with successful viral suppression (viral load < 50 copies/mL) and severe lipoatrophy at one or more body or face sites. The primary end point of the study was the change in limb fat mass as measured by dual energy X-ray absorptiometry (DEXA) scan from baseline to 48 weeks. Other end points included changes in fat as measured by a single slice abdominal computed tomography (CT) scan, lipid changes, and bone mineral density changes by DEXA.
Results: There were no discernable differences in terms of viral failure or CD4 cell count increase. The increase in limb fat mass was similar for the 2 groups, and there was no significant difference in creatinine, lactate levels, or rates of osteopenia. However, there was a modest advantage in lipid changes favoring TDF that was statistically significant. These data are summarized in the Table .
Conclusions: Switching from a thymidine nucleoside to either TDF or to ABC is associated with a significant improvement in limb fat mass. There may be a modest benefit to TDF in terms of changes in lipids.
Comment: As noted by the authors, the resolution of lipoatrophy is a prolonged process, and the authors suggest that this switch should be considered relatively early. Possibly as expected, changes in visceral fat did not change significantly in either group. There did not appear to be consequences to TDF in terms of measured renal function or bone mineral density. The rate of ABC hypersensitivity was 6%, as reported in prior reports. Somewhat surprising is the total LDL cholesterol favoring TDF, which was statistically significant but represented only a 5% change from baseline.
Moyle GJ, Sabin CA, Cartledge J, et al; for the RAVE (Randomized Abacavir versus Viread Evaluation) Group UK. A randomized comparative trial of tenofovir DF or abacavir as replacement for a thymidine analogue in persons with lipoatrophy. AIDS. 2006;20:2043-2050. The goal of the study was to determine the relative merit of abacavir (ABC) vs tenofovir (TDF) as replacement for thymidine analogues in patients with lipoatrophy.
Methods: This was a randomized, open-label trial involving the switch from zidovudine or stavudine (d4T) to either TDF or ABC among patients with successful viral suppression (viral load < 50 copies/mL) and severe lipoatrophy at one or more body or face sites. The primary end point of the study was the change in limb fat mass as measured by dual energy X-ray absorptiometry (DEXA) scan from baseline to 48 weeks. Other end points included changes in fat as measured by a single slice abdominal computed tomography (CT) scan, lipid changes, and bone mineral density changes by DEXA.
Results: There were no discernable differences in terms of viral failure or CD4 cell count increase. The increase in limb fat mass was similar for the 2 groups, and there was no significant difference in creatinine, lactate levels, or rates of osteopenia. However, there was a modest advantage in lipid changes favoring TDF that was statistically significant. These data are summarized in the Table .
Conclusions: Switching from a thymidine nucleoside to either TDF or to ABC is associated with a significant improvement in limb fat mass. There may be a modest benefit to TDF in terms of changes in lipids.
Comment: As noted by the authors, the resolution of lipoatrophy is a prolonged process, and the authors suggest that this switch should be considered relatively early. Possibly as expected, changes in visceral fat did not change significantly in either group. There did not appear to be consequences to TDF in terms of measured renal function or bone mineral density. The rate of ABC hypersensitivity was 6%, as reported in prior reports. Somewhat surprising is the total LDL cholesterol favoring TDF, which was statistically significant but represented only a 5% change from baseline.