Impact of switching from zidovudine/lamivudine to tenofovir/emtricitabine on lipoatrophy: the RECOMB study

Authors


  • The data have previously been presented in part at the XVIIth International AIDS Conference, Mexico City, Mexico, 3−8 August 2008; the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention, Cape Town, South Africa, 19−22 July 2009; the 9th International Congress on Drug Therapy in HIV Infection, Glasgow, UK, 9−13 November 2008; the 19th Conference on Retroviruses and Opportunistic Infections, Seattle, USA, 5−8 March 2012.

Correspondence: Dr Esteban Ribera, Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Paseo Vall d'Hebron 119-129, Sexta planta, 08035 Barcelona, Spain. Tel: +34 934894497; fax: +34 932746204; e-mail: eriberap@gmail.com

Abstract

Objectives

Lipoatrophy is a long-term adverse effect of some antiretrovirals that affects quality of life, compromises adherence and may limit the clinical impact of HIV treatments. This paper explores the effect of tenofovir/emtricitabine (TDF/FTC) on the amount of limb fat in patients with virological suppression.

Methods

A randomized, prospective clinical trial was performed to compare continuation on a zidovudine/lamivudine (ZDV/3TC)-based regimen with switching to a TDF/FTC-based regimen in terms of the effect on limb fat mass as assessed by DEXA over a 72-week period.

Results

Eighty patients were included (39 in the TDF/FTC arm and 41 in the ZDV/3TC arm) and 73 completed the study (37 and 36, respectively). In the switch arm, limb fat increased by a median of 540 g from baseline (P = 0.022), while in the ZDV/3TC arm it decreased by a median of 379 g (P = 0.112; p between groups = 0.007). Subjects with baseline limb fat ≤ 7200 g, previous time on ZDV > 5 years or a body mass index > 25 kg/m2 experienced higher limb fat gains than other subjects, and these differences were statistically significant. Haemoglobin increased by a median of 1.0 g/dL in the TDF/FTC arm (P < 0.001) and remained unchanged in the ZDV/3TC arm (p between groups = 0.0002). There were no significant differences between groups in other secondary endpoints (body weight, total body and trunk fat content, total body bone mineral density, laboratory parameters, CD4 cell count and viral load).

Conclusions

Switching from a ZDV/3TC-based to a TDF/FTC-based regimen led to a statistically significant improvement in limb fat, in contrast to the progressive loss of limb fat in subjects continuing ZDV/3TC.

Ancillary