Switching to lopinavir/ritonavir with or without abacavir/lamivudine in lipoatrophic patients treated with zidovudine/abacavir/lamivudine
Por:
Bernardino, JI, Pulido, F, Martinez, E, Arrizabalaga, J, Domingo, P, Portilla, J, Ocampo, A, Munoz, J, Torres, R, Arribas, JR
Publicada:
1 jun 2013
Resumen:
Discontinuation of thymidine nucleoside reverse transcriptase inhibitors (tNRTIs) is the only proven strategy for improving lipoatrophy. It is unclear whether switching to NRTI-sparing or to non-thymidine NRTI-containing therapy has differential effects on body fat recovery.
This was a 96 week, open-label, randomized study in suppressed patients with moderate/severe lipoatrophy and no prior virological failure while receiving a protease inhibitor and who had their triple NRTI regimen (zidovudine/lamivudine/abacavir) switched to lopinavir/ritonavir plus abacavir/lamivudine for a 1 month run-in period and then randomized to lopinavir/ritonavir plus abacavir/lamivudine versus lopinavir/ritonavir monotherapy. The KRETA trial is registered with ClinicalTrials.gov (number NCT00865007).
Of 95 patients included, 88 were randomized to lopinavir/ritonavir plus abacavir/lamivudine (n44) or lopinavir/ritonavir monotherapy (n44). Median (IQR) baseline limb fat was 2.5 (1.63.7) kg in the lopinavir/ritonavir plus abacavir/lamivudine group and 2.5 (2.05.4) kg in the lopinavir/ritonavir monotherapy group. Six patients in the triple therapy group and 13 in the monotherapy group had discontinued study drugs by week 96. Although there were limb fat gains in each group at weeks 48/96 (324/358 g in lopinavir/ritonavir plus abacavir/lamivudine, P0.09/0.07, versus 215/416 g in the lopinavir/ritonavir monotherapy group, P0.28/0.16), differences between groups were not significant [difference 109 g (95 CI 442, 660)/57 g (95 CI 740, 625)].
In lipoatrophic patients treated with zidovudine/lamivudine/abacavir, switching to lopinavir/ritonavir monotherapy had no additional benefit in limb fat recovery relative to switching to lopinavir/ritonavir with abacavir/lamivudine. These data suggest that non-thymidine nucleosides such as abacavir/lamivudine are not an obstacle to limb fat recovery.
Filiaciones:
Bernardino, JI:
Hosp Univ La Paz, IDIPAZ, Madrid, Spain
Pulido, F:
Hosp Univ 12 Octubre i 12, Madrid, Spain
Martinez, E:
Univ Barcelona, Hosp Clin, Inst Invest Biomed August Pi & Sunyer, Barcelona, Spain
Arrizabalaga, J:
Hosp Donostia, San Sebastian, Spain
Domingo, P:
Univ Barcelona, Hosp Santa Creu & San Pau, Barcelona, Spain
Portilla, J:
Hosp Gen Alicante, Alicante, Spain
Ocampo, A:
Complexo Hosp Univ Vigo, Pontevedra, Spain
Munoz, J:
Hosp Basurto, Bilbao, Spain
Torres, R:
Hosp Severo Ochoa, Madrid, Spain
Arribas, JR:
Hosp Univ La Paz, IDIPAZ, Madrid, Spain
Bronze
|