A randomized comparative trial of tenofovir DF or abacavir as replacement for a thymidine analogue in persons with lipoatrophy

RAVE (Randomized Abacavir versus Viread Evaluation) Group UK, Graeme J Moyle, Caroline A Sabin, Jonathan Cartledge, Margaret Johnson, Edmund Wilkins, Duncan Churchill, Philip Hay, Ade Fakoya, Maurice Murphy, George Scullard, Clifford Leen, Geraldine Reilly

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Long-term antiretroviral therapy, while dramatically reducing HIV-related morbidity and mortality, is associated with metabolic and morphological changes. Peripheral fat loss, lipoatrophy, appears most associated with prolonged therapy with thymidine nucleoside analogues.

Methods: A randomized, open-label, comparative study of switching from a thymidine nucleoside analogue to either tenofovir disoproxil fumarate (DF) or abacavir in 105 individuals on successful antiretroviral therapy with clinically evident moderate to severe lipoatrophy.

Results: Individuals were randomized to tenofovir DF (52) or abacavir (53). The switch was well tolerated and the majority of patients completed 48 weeks of study. One individual in the tenofovir DF group and three in the abacavir group discontinued due to drug-related adverse events. Both groups similarly maintained virological control. Limb fat mass increased similarly in both groups: mean increases by week 48 of 329 and 483 g in tenofovir DF and abacavir groups, respectively [mean 95% confidence interval for difference, −154.3 (range −492.8 to 184.3)]. This change from baseline was statistically significant in both groups (tenofovir DF, P = 0.01; abacavir, P = 0.0001). Mean total cholesterol, low density lipoprotein cholesterol and triglycerides improved modestly with switching to tenofovir DF but were unchanged with abacavir. The changes in these parameters were significantly greater in the tenofovir DF arm relative to abacavir.

Conclusions: Switching from a thymidine nucleoside analogue to either tenofovir DF or abacavir leads to significant improvement in limb fat mass over 48 weeks. Tenofovir DF may have modest advantages over abacavir for changes in lipids. Peripheral lipoatrophy, when clinically apparent, resolves slowly following treatment switching.
Original languageEnglish
Pages (from-to)2043-2050
Number of pages8
JournalAIDS
Volume20
Issue number16
DOIs
Publication statusPublished - 24 Oct 2006

Keywords

  • Adenine
  • Adult
  • Aged
  • Anti-HIV Agents
  • Biological Markers
  • Body Fat Distribution
  • Dideoxynucleosides
  • Female
  • HIV Infections
  • HIV-Associated Lipodystrophy Syndrome
  • Humans
  • Lipids
  • Male
  • Middle Aged
  • Organophosphonates
  • Reverse Transcriptase Inhibitors
  • Stavudine
  • Zidovudine

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