Normalization of fat accrual in lipoatrophic, HIV-infected children switched from stavudine to tenofovir and from protease inhibitor to efavirenz.
OBJECTIVE
An antiretroviral regimen based on lamivudine+stavudine+protease inhibitor impairs peripheral fat accrual in HIV-infected children and adolescents. We assess the effect on body composition parameters of replacing stavudine with tenofovir and protease inhibitor with efavirenz in paediatric patients.


METHODS
A 96-week prospective study on 24 patients, (age range: 5.0-17.9 years) with stable undetectable HIV-1 loads, who were switched from stavudine to tenofovir and from protease inhibitor to efavirenz. Patient assessment included: body composition parameters measured by dual-energy X-ray absorptiometry (DXA), viral load and CD4+ T-count and percentage. As a control group for DXA data, we studied 143 healthy controls (HCs; age range: 4.9-20.0 years).


RESULTS
Virological suppression and unchanged CD4+ T-cell count and percentage were maintained in all patients. At baseline, patients showed decreased total, arm and leg fat masses (P < 0.01) but a similar trunk fat mass to HCs. From baseline to week 96, patient fat mass increases were comparable to those for HCs (total fat: 1.3 vs 1.2 kg; fat in arms: 0.09 vs 0.08 kg; fat in legs: 0.5 vs 0.5 kg; trunk fat: 0.6 vs 0.6 kg). However, at week 96, total and leg fat mass in patients were still significantly lower than those in HCs (P < 0.02). At baseline and at week 96, lean mass in patients was similar to that expected in HCs.


CONCLUSIONS
Replacing stavudine with tenofovir and protease inhibitor with efavirenz for 96 weeks in lipoatrophic paediatrics patients led to a restoration of physiological fat accrual. Lipoatrophy did not progress but was still present, indicating the need for additional strategies.
Viganò
Alessandro
A
Department of Paediatrics, L Sacco Hospital, University of Milan, Italy. alessandra.vigano@unimi.it
Brambilla
Paolo
P
Cafarelli
Laura
L
Giacomet
Vania
V
Borgonovo
Simona
S
Zamproni
Ilaria
I
Zuccotti
Gianvincenzo
G
Mora
Stefano
S
D015502:Absorptiometry, Photon; D000225:Adenine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000293:Adolescent; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001284:Atrophy / Q000473:pathology; D048588:Benzoxazines / Q000627:therapeutic use*; D001823:Body Composition / Q000187:drug effects; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003521:Cyclopropanes; D005260:Female; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology / Q000821:virology; D006801:Humans; D007558:Italy; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use*; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018119:Stavudine / Q000009:adverse effects / Q000627:therapeutic use*; D000068698:Tenofovir; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D063065:Organophosphonates; D011480:Protease Inhibitors; D000068698:Tenofovir; D018119:Stavudine; D000225:Adenine; C098320:efavirenz