What
Is the Impact on Lipoatrophy and Dyslipidemia of Reducing the Dose of d4T (Zerit)
Compared with Switching to Tenofovir (Viread)?
 ZERIT
CAPSULE |
 VIREAD
PILL |
The results of numerous
studies have shown that antiretroviral regimens containing d4T
(stavudine; Zerit) are
associated with a potential for lipoatrophy (fat loss)
and dyslipidemia (abnormal blood lipid levels).
In an effort to manage these adverse events, researchers at the Hospital
Clinic Barcelona assessed the safety and efficacy of reducing the dose of d4T
compared with switching to tenofovir
(Viread) or maintaining the standard dose of
d4T.
The study included clinically stable HIV-infected patients receiving antiretroviral
therapy containing 40 mg twice daily d4T who had plasma HIV RNA < 200 copies/mL
for at least 6 months. Participants were randomized as follows:
Results
•
58
patients (93% male) were included: 22 in the d4T-40 arm, 19 in the d4T-30 arm
and 17 in the tenofovir arm.
•
At baseline, the median time on d4T
was 6 years, the median age was 43 years, and the median CD4 T-cell count was
587 cells/mm3.
•
At week 24, median limb fat changes
(in grams) were as follows:
•
d4T-40: -182
g;
•
d4T-30: 527 g;
•
tenofovir: 402
g (P = 0.0003 d4T-40 vs tenofovir).
•
Significant differences between median
laboratory values were observed:
•
Triglycerides:
•
d4T-40: 19 mg/dL;
•
d4T-30: -23 mg/dL;
•
tenofovir: -79
mg/dL (P = 0.03 d4T-40 vs tenofovir);
•
Total cholesterol:
•
d4T-40: 22 mg/dL;
•
d4T-30: -4 mg/dL;
•
tenofovir: -28
mg/dL (P = 0.04 d4T-40 vs tenofovir).
•
No significant difference was observed
in mitochondrial function assessed in peripheral blood mononuclear cells.
Conclusion
The
study authors wrote in conclusion, “Although both strategies were associated with
a trend toward a decrease in plasma lipids and an increase in body fat, the only
significant changes were observed among those who switched to tenofovir.”
Infectious Diseases Unit, Hospital
Clinic Barcelona, Barcelona, Spain.
01/15/08
Reference
A Milinkovic, E Martinez, S Lopez, and others. The Impact of reducing stavudine dose versus
switching to tenofovir on plasma lipids, body composition and mitochondrial function in HIV-infected
patients. Antiviral Therapy 12(3): 407-415. 2007.
