(Reuters Health) - Switching from a thymidine nucleoside analogue to tenofovir or abacavir can improve the loss of limb fat mass in HIV-infected patients with lipoatrophy, according to a report in the October 24th issue of AIDS.
"Switching helps lipoatrophy and maintains treatment benefits, but fat recovery is very slow, so prevention is always better," Dr. Graeme J. Moyle from Chelsea and Westminster Hospital, London, UK told Reuters Health.
Dr. Moyle and colleagues in the Randomized Abacavir versus Viread Evaluation (RAVE) group investigated the effects on limb fat of switching from a thymidine analogue to tenofovir DF as an alternative to abacavir, which has already been shown to improve lipoatrophy.
The trial involved 105 patients on successful antiretroviral therapy with moderate to severe lipoatrophy.
Median limb fat increased to a similar extent among tenofovir DF and abacavir recipients, the investigators report. Subcutaneous adipose tissue increased modestly over 48 weeks, but visceral adipose tissue showed no substantial change.
Patients who had been taking stavudine experienced greater increases in limb fat than did patients who had been taking zidovudine before the switch, the results indicate.
Lipid parameters improved after the switch to tenofovir DF, the researchers note, but there was no change after switching to abacavir.
Most laboratory markers remained unchanged after the switch from a thymidine analogue to tenofovir DF or abacavir, the team found, although tenofovir DF patients experienced significant increases in hemoglobin and patients in both groups had significant declines in plasma lactate levels.
"This study establishes tenofovir DF as an alternative to abacavir when switching from a thymidine analogue for lipoatrophy," the authors conclude. "Where feasible, consideration should be given to proactive switching away from thymidine analogue to either tenofovir DF or abacavir."
Dr. Moyle added, "I don't think the study suggests important differences between tenofovir DF and abacavir, so the choice is based on other considerations, such as cost."
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