The purpose of the present study, conducted at the University of Colorado Health Sciences Center in Denver and reported in the May 1, 2008 Journal of Acquired Immune Deficiency Syndromes, was to assess long-term changes in subcutaneous tissue among 308 antiretroviral-naive individuals starting 1 of 3 nucleoside reverse transcriptase inhibitor (NRTI)-containing regimens:

• stavudine (d4T; Zerit) + lamivudine (3TC; Epivir) (n = 63);
• zidovudine (AZT; Retrovir) + lamivudine (n = 192);
• abacavir (Ziagen) + lamivudine (n = 53).

In addition to the NRTI backbone, participants' regimens also included protease inhibitors and/or non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Anthropometric measurements (skinfolds) were performed at baseline and at 4-month intervals. Rates of change over 36 months, for the early period (months 4 through 12), and for the late period (months 16 through 36), were calculated.

Results

• Rates of change were negative (tissue loss) for the abdomen and thigh skinfolds among patients taking stavudine or zidovudine, and for the triceps among patients taking zidovudine.

• " Most rates were positive (tissue gain) for patients taking abacavir.

• No differences among regimens were observed for rates of change in the subscapular or suprascapular (below or above the shoulder blade) skinfolds.

• Rates of change during the early follow-up period were generally positive.

• Rates of change during the late period were negative for stavudine and for zidovudine, and were significantly different from 0 for the abdomen and thigh (stavudine and zidovudine) and triceps (zidovudine) skinfolds.

• Patients taking abacavir experienced less loss in the late period.

• Most early versus late differences were significant for stavudine and for zidovudine.

• Only the triceps skinfold was significant for abacavir.

Conclusion

"In this prospective nonrandomized evaluation, subcutaneous tissue changes varied by regimen," wrote the study authors. They also noted that "similar losses" were shown for stavudine + lamivudine and zidovudine + lamivudine, while abacavir + lamivudine "had gains."

Further, they concluded, "Temporal differences in rates for [stavudine + lamivudine] and [zidovudine + lamivudine] suggest initial recovery followed by long-term [negative] treatment effect."

Denver Community Programs for Clinical Research on AIDS, University of Colorado Health Sciences Center, Denver, CO.

5/30/08

Reference

JC Shlay, S Sharma, G Peng, and others. Long-term subcutaneous tissue changes among antiretroviral-naive persons initiating stavudine, zidovudine, or abacavir with lamivudine. Journal of Acquired Immune Deficiency Syndromes 48(1): 53-62. May 1, 2008.

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