Improvements in subcutaneous fat, lipid profile, and parameters of mitochondrial toxicity in patients with peripheral lipoatrophy when stavudine is switched to tenofovir (LIPOTEST study).
BACKGROUND
Lipoatrophy is the most stigmatizing side effect of stavudine therapy. We assessed the long-term effects of replacing stavudine with tenofovir in HIV-infected patients with lipoatrophy.


METHODS
Prospective switch study. Sixty-two clinically stable patients with antiretroviral therapy (ART) containing stavudine, HIV-1 RNA <50 copies/mL, and lipoatrophy at least in the face on physical examination were included. All patients switched from stavudine to tenofovir without changing any other drug. Objective (malar ultasonography, bioelectrical impedance analysis) and subjective measures of lipoatrophy were assessed.


RESULTS
Median age at baseline was 40 years, 44 patients (71%) were male, and median time on stavudine was 4.8 years. Median malar fat thickness increased 0.8 mm (25%) 24 months after switching. Total fat mass increased 3.9 kg (21%). Plasma lactate levels decreased significantly, mainly in patients with baseline hyperlactatemia (from 3.05 to 1.19 mmol/L). Significant improvement in total cholesterol (-12%), triglycerides (-31%), and total cholesterol/HDL cholesterol ratio (-11%) was observed at Month 24.


CONCLUSIONS
In this study, switching from stavudine to tenofovir maintained durable virologic suppression when the HAART regimen included a protease inhibitor or a non-nucleoside reverse transcriptase inhibitor, led to a slow improvement of lipoatrophy, and improved the lipid profile and lactate levels with excellent tolerability. These results support the proactive change of stavudine to tenofovir.
Ribera
Esteban
E
Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain. eribera@vhebron.net
Paradiñeiro
José Carlos
JC
Curran
Adria
A
Sauleda
Silvia
S
García-Arumí
Elena
E
Castella
Eva
E
Puiggròs
Carolina
C
Crespo
Manuel
M
Feijoo
Maria
M
Diaz
Marjorie
M
Del Saz
Sara Villar
SV
Planas
Merçè
M
Sureda
Delia
D
Falcó
Vicenç
V
Ocaña
Imma
I
Pahissa
Albert
A
D000225:Adenine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001823:Body Composition / Q000187:drug effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005145:Face; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007773:Lactates / Q000097:blood; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008928:Mitochondria / Q000187:drug effects; D063065:Organophosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018119:Stavudine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging / Q000187:drug effects; D000068698:Tenofovir; D016896:Treatment Outcome; D014463:Ultrasonography
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D007773:Lactates; D008055:Lipids; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D018119:Stavudine; D000225:Adenine