Switching from Stavudine to Tenofovir Decreases Cardiovascular Risk

By Brian Boyle, MD

Hypertriglyceridemia has been linked to stavudine/d4T (Zerit) exposure and in several studies an improvement of hypertriglyceridemia has occurred in patients switching from d4T to tenofovir DF/ TDF (Viread). In a study presented at the 3rd IAS in Rio de Janeiro, the impact of switching from d4T to TDF on the cardiovascular risk factors in HIV-infected patients with lipoatrophy and undetectable HIV viral load was assessed.

In this prospective, observational, multi-center study, 237 patients (mean age of 43 years, 73.4% male) with lipoatrophy and undetectable HIV viral load were enrolled at 120 Spanish treatment centers from September 2002 to September 2004. All patients who switched from d4T to TDF due to lipoatrophy were analyzed regarding fasting lipids at baseline and 48 weeks after the switch. Cardiovascular risk was estimated using the Framingham equation.

After 48 weeks of TDF therapy, no patient had withdrawn due to virologic failure or adverse events. Cardiovascular risk factors, at baseline and 48 weeks after switching from d4T to TDF, are shown in the table below and demonstrate improvements in triglycerides, total cholesterol and LDL cholesterol:

*P < 0.01 refers to difference between baseline and Week 48

The authors conclude, “Switching from d4T to TDF was well-tolerated and the virological and immunological response was maintained. Switching from d4T to TDF was associated with statistically significant reduction in cardiovascular risk.”

08/05/05

Reference
Palacios and others. Impact of Switching from Stavudine (d4T) to Tenofovir DF (TDF) on Cardiovascular (CV) Risk Factors in Patients with Lipoatrophy (LIPO-REC Study). Abstract TuPe23C15 (poster). Program and Abstracts of the 3^rd IAS Conference on HIV Pathogenesis and Treatment. July 24-27, 2005. Rio de Janeiro.

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