title: Improvements in subcutaneous fat, lipid profile, and parameters of mitochondrial toxicity in patients with peripheral lipoatrophy when stavudine is switched to tenofovir (LIPOTEST study).
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Barcelona, Spain. eribera@vhebron.net
authors.forename: Esteban
authors.initials: E
authors.lastname: Ribera
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Paradiñeiro
authors.forename: Adria
authors.initials: A
authors.lastname: Curran
authors.forename: Silvia
authors.initials: S
authors.lastname: Sauleda
authors.forename: Elena
authors.initials: E
authors.lastname: García-Arumí
authors.forename: Eva
authors.initials: E
authors.lastname: Castella
authors.forename: Carolina
authors.initials: C
authors.lastname: Puiggròs
authors.forename: Manuel
authors.initials: M
authors.lastname: Crespo
authors.forename: Maria
authors.initials: M
authors.lastname: Feijoo
authors.forename: Marjorie
authors.initials: M
authors.lastname: Diaz
authors.forename: Sara Villar
authors.initials: SV
authors.lastname: Del Saz
authors.forename: Merçè
authors.initials: M
authors.lastname: Planas
authors.forename: Delia
authors.initials: D
authors.lastname: Sureda
authors.forename: Vicenç
authors.initials: V
authors.lastname: Falcó
authors.forename: Imma
authors.initials: I
authors.lastname: Ocaña
authors.forename: Albert
authors.initials: A
authors.lastname: Pahissa
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D007773:Lactates; D008055:Lipids; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D018119:Stavudine; D000225:Adenine