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Frequency of lipodystrophy in a large observational cohort using either LPV/r or EFV in combination with contemporary nucleoside analogues
J. van Lunzen1, R. Pauli2, A. Trein3, A. Mutz4, S. Hansen5, K. Fischer6
1University Medical Center Hamburg-Eppendorf, Infectious Diseases Unit, Hamburg, Germany, 2Practice Pauli/Becker, Munich, Germany, 3HIV Center, Stuttgart, Germany, 4Klinikum Natruper Holz, Osnabrück, Germany, 5ICH (Infektionsmedizinisches Centrum Hamburg), Hamburg, Germany, 6Practice Schranz/Fischer, Berlin, Germany
Background: A higher rate of lipoatrophy (LA) was reported in randomized clinical trials (e.g. ACTG 5142) in association with the use of efavirenz (EFV) compared to boosted lopinavir (LPV/r). However, this effect was preferentially observed in patients receiving these drugs in combination with more toxic nucleoside (NA) backbones (e.g. d4T, ddI, AZT). Clinical observations with more contemporary NA are largely missing.
Objective: Comparison of frequency of lipoatrophy of EFV vs. LPV/r in combination with contemporary NA.
Methods: Patients were enrolled into this cross-sectional analysis after informed consent. LA was assessed by the treating physician and the patient using standardized questionnaires. Medical and treatment history, anthropometric and laboratory data were analysed to detect any differences or associations by descriptive statstics.
Results: A total of 332 patients were enrolled (165 EFV vs. 139 LPV/r), 28 pts. were not eligible for analysis. Groups were well matched concerning characteristics at baseline and time of observation (VL, CD4, gender, ethnicity, NA backbone). Median duration of therapy was 3.5 years, TDF/FTC or 3TC was the most frequently used NA backbone (45%), followed by ABC/3TC (12%). TG were higher in the LPV/r group (median 206 vs. 145mg/dl, p< 0.05), no differences were detected in LDL and HDL cholesterol; CD4 count increase from baseline was identical (+303 cells/µl). Significant differences were observed in favour of LPV/r in waist to hip ratio, loss of limb fat and lipaccumulation in breasts (p< 0.05) with a high concordance of physician and self reported assessments. These changes were most pronounced in pts. using AZT, d4T or ddI as a NA backbone.
Conclusions: EFV and LPV/r containing regimens were equally effective in this observational cohort. Despite higher TG levels in the LPV/r group, more limb fat loss and trunk fat accumulation was reported in the EFV group even in combination with contemporary NA backbones (TDF/FTC or 3TC/ABC).
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