As
reported in the June 1, 2007 Journal of Acquired Immune Deficiency Syndromes,
Pablo Tebas, MD, and colleagues evaluated the effects of NRTI-sparing and PI-sparing
regimens on body fat distribution, bone mineral density, and metabolic parameters
in 62 HIV positive participants who were not selected for lipoatrophy (ACTG Study
5125s). Subjects had advanced HIV disease (lowest-ever CD4 count of 200 cells/mm3
or less, or highest-ever HIV RNA level of 80,000 copies/mL or greater), but had
undetectable viral loads on therapy at the time of the study.
Participants
were randomly assigned to switch from their successful current antiretroviral
combination to one of the following regimens:
• At week 48,
the median change in limb fat in the NRTI-sparing arm was 562 g (+6%), compared
with a loss of 242 g (-4%) in the PI-sparing arm (P = 0.086).
•
At the time of the last observation (median 102 weeks), patients
in the NRTI-sparing arm experienced a median limb fat gain of 782 g (+10%), while
those in the PI-sparing arm had lost 850 g (-15%) (P = 0.002).
•
However, subjects in the NRTI-sparing arms experienced larger
increases in total cholesterol and triglyceride levels.
Conclusion
"The
switch to a nucleoside-sparing combination antiretroviral regimen (lopinavir/ritonavir
+ efavirenz) was associated with
significant improvement in limb fat," the investigators concluded.
They
added that, "These results provide additional evidence that nucleoside analogues
[NRTIs] are important in the progressive limb fat loss that characterizes antiretroviral
treatment and that switching medications can significantly improve this complication."
However,
they cautioned, "This option has to be carefully balanced with the potential
to increase serum lipid levels and the trend to increase virologic failure."
University
of Pennsylvania, Philadelphia, PA; Harvard School of Public Heath, Boston, MA;
Washington University School of Medicine, St. Louis, MO; University of Miami School
of Medicine, Miami, FL; University of Cincinnati Medical Center, Cincinnati, OH;
University of Washington School of Medicine, Seattle, WA; University of Hawaii,
Honolulu, HI; Social and Scientific Systems, Silver Spring, MD; University of
Southern California, Los Angeles, CA; Tufts University, Boston, MA.
07/03/07
Reference P
Tebas, J Zhang, K Yarasheski, and others. Switching to a Protease Inhibitor-Containing,
Nucleoside-Sparing Regimen (Lopinavir/Ritonavir Plus Efavirenz) Increases Limb
Fat But Raises Serum Lipid Levels: Results of a Prospective Randomized Trial (AIDS
Clinical Trial Group 5125s). JAIDS 45(2): 193-200. June 1, 2007.
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