Improvement of lipoatrophy by switching from efavirenz to lopinavir/ritonavir
Por:
Rojas, J, Lonca, M, Imaz, A, Estrada, V, Asensi, V, Miralles, C, Domingo, P, Montero, M, del Rio, L, Fontdevila, J, Perez, I, Cruceta, A, Gatell, JM, Arnedo, M, Martinez, E
Publicada:
1 may 2016
Resumen:
ObjectiveTo assess whether changes in antiretroviral drugs other than thymidine nucleoside reverse transcriptase inhibitors (NRTI) may have a body fat impact in HIV-infected patients with lipoatrophy.
MethodsNinety-six-week phase IV, open-label, multicentre, pilot randomized trial. HIV-infected patients with moderate/severe lipoatrophy at one or more body sites despite long-term thymidine NRTI-free therapy were randomized to continue their efavirenz (EFV)-based antiretroviral regimen or to switch from EFV to lopinavir/ritonavir (LPV/r). The primary endpoint was the absolute change in limb fat mass measured by dual X-ray absorptiometry from baseline to 96weeks. Changes in other body fat measurements, subjective perception of lipoatrophy, subcutaneous fat gene expression and plasma lipids were also assessed.
ResultsThirty-three patients (73% men, median age 52years) were recruited. At 96weeks, absolute limb fat mass increased in the LPV/r arm vs. the EFV arm (estimated difference +1082.1g; 95% CI +63.7 to +2103.5; P=0.04); this difference remained significant after adjustment by gender, age, fat mass, body mass index and CD4 cell count at baseline. Subjective lipoatrophy perception scores also improved in the LPV/r arm relative to the EFV arm. Adipogenesis, glucose and lipid metabolism, and mitochondrial gene expression increased in the LPV/r arm compared with the EFV arm at 96weeks. HDL cholesterol decreased in the LPV/r arm relative to the EFV arm.
ConclusionsSwitching from EFV to LPV/r in HIV-infected patients with lipoatrophy may offer further limb fat gain beyond thymidine NRTI discontinuation, although this strategy decreased plasma HDL cholesterol and caused changes in subcutaneous fat gene expression that may be associated with increased insulin resistance.
Filiaciones:
Rojas, J:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
Lonca, M:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
Imaz, A:
Univ Barcelona, Hosp Univ Bellvitge, Lhospitalet De Llobregat, Spain
Estrada, V:
Univ Complutense Madrid, Hosp Clin San Carlos, Madrid, Spain
Asensi, V:
Hosp Univ Cent Asturias, Oviedo, Spain
Miralles, C:
Complexo Hosp Univ Vigo, Vigo, Spain
Domingo, P:
Univ Autonoma Barcelona, Hosp St Pau, E-08193 Barcelona, Spain
Montero, M:
Hosp Univ & Politecn La Fe, Valencia, Spain
del Rio, L:
CETIR Grp Med, Barcelona, Spain
Fontdevila, J:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
Perez, I:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
Cruceta, A:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
Gatell, JM:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
Arnedo, M:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
Martinez, E:
Univ Barcelona, Hosp Clin IDIBAPS, E-08036 Barcelona, Spain
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