Improvements in cheek volume in lipoatrophic individuals switching away from thymidine nucleoside reverse transcriptase inhibitors.
BACKGROUND
Thymidine nucleoside reverse transcriptase inhibitors (NRTIs) are associated with subcutaneous fat loss. Facial changes cannot be assessed by dual-energy X-ray absorptiometry (DEXA) scans. There are limited objective data on the reversibility of facial lipoatrophy.


METHODS
We performed a facial volume substudy of a randomized thymidine NRTI replacement study carried out in HIV-infected subjects with moderate to severe lipoatrophy. Facial volume changes were assessed using validated 3D laser imaging. Changes in body composition were measured using DEXA scans. The association between changes in facial volume and body composition parameters at 48 weeks was measured using Spearman's rank correlation.


RESULTS
Forty-seven individuals (46 male), 11 receiving zidovudine and 36 receiving stavudine, switched to either tenofovir disoproxil fumarate (DF) (n=23) or abacavir (ABC) (n=24). Thirty-nine of these 47 patients (84.8%) reported facial lipoatrophy at baseline. The median volume increase in both cheeks from baseline was 1857.3 mm(3). These volume changes and increases in limb fat at 48 weeks were similar in the two groups and correlated significantly (Spearman's r=0.41, P=0.004).


CONCLUSIONS
Facial volume in lipoatrophic individuals was found to increase after thymidine NRTI replacement. We demonstrated a significant correlation between improvements in facial and limb fat parameters. Switching from thymidine NRTIs in patients with facial lipoatrophy could potentially reduce the need for cosmetic interventions.
Benn
P
P
Department of Genitourinary Medicine, Mortimer Market Centre, Camden PCT, Off Capper Street, London WC1E 6JB, UK. paul.benn@camdenpct.nhs.uk
Sauret-Jackson
V
V
Cartledge
J
J
Ruff
C
C
Sabin
C A
CA
Moyle
G
G
Linney
A
A
Reilly
G
G
Edwards
S G
SG
D015502:Absorptiometry, Photon; D000225:Adenine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001823:Body Composition / Q000187:drug effects* / Q000502:physiology; D002610:Cheek / Q000473:pathology; D015224:Dideoxynucleosides / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000627:therapeutic use; D011788:Quality of Life; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects*; D018119:Stavudine / Q000627:therapeutic use; D000068698:Tenofovir; D015215:Zidovudine / Q000627:therapeutic use; D000099227:Abacavir
D000225:Adenine; D015224:Dideoxynucleosides; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine; D000068698:Tenofovir; D015215:Zidovudine; D000099227:Abacavir