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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, Martínez E. Improvement of lipoatrophy by switching from efavirenz to lopinavir/ritonavir. HIV Med 2015; 17:340-9. [PMID: 27089862 DOI: 10.1111/hiv.12314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To 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. METHODS Ninety-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 96 weeks. Changes in other body fat measurements, subjective perception of lipoatrophy, subcutaneous fat gene expression and plasma lipids were also assessed. RESULTS Thirty-three patients (73% men, median age 52 years) were recruited. At 96 weeks, absolute limb fat mass increased in the LPV/r arm vs. the EFV arm (estimated difference +1082.1 g; 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 96 weeks. HDL cholesterol decreased in the LPV/r arm relative to the EFV arm. CONCLUSIONS Switching 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.
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Affiliation(s)
- J Rojas
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - M Lonca
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - A Imaz
- Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - V Estrada
- Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - V Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - C Miralles
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - P Domingo
- Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Montero
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - J Fontdevila
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - I Perez
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - A Cruceta
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J M Gatell
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - M Arnedo
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - E Martínez
- Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Blanco JL, Biglia A, Martinez E, Sánchez M, de Lazzari E, Leon A, Milinkovic A, Larrousse M, Lonca M, Laguno M, Mallolas J, Gatell JM. Intrathoracic fat in HIV-infected patients. HIV Med 2006; 7:213-7. [PMID: 16630033 DOI: 10.1111/j.1468-1293.2006.00361.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of HIV infection or antiretroviral therapy on the intrathoracic fat compartment is unknown. METHODS Consecutive clinically stable HIV-infected adult patients, irrespective of exposure to antiretroviral therapy, and non-HIV-infected healthy volunteers, both without clinical evidence of body fat changes consistent with lipodystrophy and adjusted for age, gender and body mass index, were recruited for this study. Thoracic and abdominal fat was assessed by computed tomography and compared between patients and controls. RESULTS There were nine women (33%) and 18 men (67%) in each group. Nineteen patients (70%) had been taking antiretrovirals for a median of 8 months (interquartile range: 6-11). Among the HIV-infected patients, intrathoracic fat (median; interquartile range) did not differ significantly between treated (6.7 cm(2); 4.5-8.3 cm(2)) and untreated (6.9 cm(2); 5.7-10.9 cm(2)) individuals (P=0.288). However, intrathoracic fat content (median; interquartile range) was higher in HIV-infected patients (6.8 cm(2); 5.6-10.5 cm(2)) than in controls (5.6 cm(2); 3.9-6.7 cm(2)) (P=0.025). Intrathoracic fat was positively correlated with intra-abdominal fat both in patients (rho=0.6, P=0.002) and in controls (rho=0.7, P=0.004). CONCLUSION In HIV-infected adults without clinical evidence of lipodystrophy, intrathoracic fat content was higher than in healthy persons and positively correlated with intra-abdominal fat content.
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Affiliation(s)
- J L Blanco
- Infectious Diseases Unit, Hospital Clinic-Institut d'Investigaciones Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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Negredo E, Paredes R, Peraire J, Pedrol E, Côté H, Gel S, Fumaz CR, Ruiz L, Abril V, de Castro ER, Ochoa C, Martinez-Picado J, Montaner J, Rey-Joly C, Clotet B, Clotet B, Ruiz L, Martinez-Picado J, Gel S, Fumaz CR, Muñoz-Moreno JA, Bonjoch A, Martínez JC, Miranda J, Puig J, Arisa ER, Tuldrà A, Bonjoch A, Jou A, Tural C, Sirera G, Romeu J, Negredo E, Zala C, Ochoa C, Cahn P, Torres O, Domingo P, Vilaró J, Llibre JM, Peraire J, Vidal F, Richart C, Viladés C, Martín L, Rodríguez R, Mata R, Viciana P, Abril V, Rubio R, Torralba M, Cervantes M, Gatell JM, Lonca M, Ruiz I, Azuaje C, Pedrol E, Rodríguez de Castro E. Alternation of Antiretroviral Drug Regimens for HIV Infection. Efficacy, Safety and Tolerability at Week 96 of the Swatch Study. Antivir Ther 2004. [DOI: 10.1177/135965350400900602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Alternation of antiretroviral drug regimens has been proposed as a novel treatment strategy for HIV infection. However, some concerns persist regarding antiviral efficacy, adherence, toxicity and resistance evolution in the long term. Methods A total of 161 antiretroviral-naive HIV-1-infected patients were randomized to receive stavudine/ didanosine/efavirenz (group A) or zidovudine/lamivudine/ nelfinavir (group B) or to alternate between the two regimens every 3 months starting with regimen A (group C). Antiviral efficacy, adherence, safety and tolerability were analysed every 12 weeks. Results After 96 weeks, time to virological failure was significantly delayed in the alternating regimen compared with the standards of care regimens. Virological suppression was seen in 46%, 48% and 58% of patients in groups A, B and C, respectively, in the intention-to-treat analysis and in 75%, 76% and 97% in the on-treatment analysis (A vs C: P=0.014; B vs C: P=0.016; A vs B: P=0.849). At the end of the study, 94% of patients in group A and 92% in groups B and C reported an adherence greater than 95%. Alternating therapy was associated with a similar impact on CD4+ counts in comparison with the standards of care regimens, as well as a lower mitochondrial DNA/nuclear DNA (mtDNA/nDNA) ratio decrease in the mitochondrial substudy performed on 37 patients. The frequency and intensity of adverse events in the alternating group decreased during subsequent cycles. Discussion Our results favour the hypothesis that proactive therapy switching may delay the accumulation of resistance mutations. Moreover, the alternating regimen was well tolerated and adherence remained comparably high in all treatment groups. The lower mtDNA/nDNA ratio decrease observed in this group may imply a lower impact on mitochondrial toxicity than in standard regimens.
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Affiliation(s)
| | - Eugenia Negredo
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Roger Paredes
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Helene Côté
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Silvia Gel
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Carmina R Fumaz
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Lidia Ruiz
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | | | - Javier Martinez-Picado
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Celestino Rey-Joly
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Bonaventura Clotet
- Department of Internal Medicine and Lluita contra la SIDA and IrsiCaixa Foundations, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - B Clotet
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - L Ruiz
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | | | - S Gel
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - CR Fumaz
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | | | - A Bonjoch
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - JC Martínez
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - J Miranda
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - J Puig
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - ER Arisa
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - A Tuldrà
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - A Bonjoch
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - A Jou
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - C Tural
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - G Sirera
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - J Romeu
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - E Negredo
- Hosp Univ Germans Trias i Pujol, Barcelona, Spain
| | - C Zala
- Fundacion Huesped, Buenos Aires, Argentina
| | - C Ochoa
- Fundacion Huesped, Buenos Aires, Argentina
| | - Pedro Cahn
- Fundacion Huesped, Buenos Aires, Argentina
| | - O Torres
- Hosp Santa Creu i Sant Pau, Barcelona, Spain
| | - P Domingo
- Hosp Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - F Vidal
- Hosp Joan XXIII, Tarragona, Spain
| | | | | | | | | | - R Mata
- Hosp Virgen del Rocío, Sevilla, Spain
| | - P Viciana
- Hosp Virgen del Rocío, Sevilla, Spain
| | - V Abril
- Hosp General Universitario, Valencia, Spain
| | - R Rubio
- Hosp 12 de Octubre, Madrid, Spain
| | | | | | | | - M Lonca
- Hosp Clínic, Barcelona, Spain
| | - I Ruiz
- Hosp del Valle Hebrón, Barcelona, Spain
| | - C Azuaje
- Hosp del Valle Hebrón, Barcelona, Spain
| | - E Pedrol
- Hosp de Granollers, Barcelona, Spain
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