Abstract
BackgroundLipoatrophy and/or central fat gain are observed frequently in patients on antiretroviral therapy (ART). Both are assumed to be antiretroviral adverse drug reactions.MethodsWe conducted a systematic review to determine whether fat loss or gain was more common in HIV-infected patients on ART than in uninfected controls; was associated with specific antiretrovirals; and would reverse after switching antiretrovirals.ResultsTwenty-seven studies met our inclusion criteria. One cohort study reported more lipoatrophy, less subcutaneous fat gain, but no difference in central fat gain in HIV-infected patients on ART than in controls. Randomised controlled trials (RCTs) showed more limb fat loss (or less fat gain) with the following regimens: stavudine (versus other nucleoside reverse transcriptase inhibitors (NRTIs)); efavirenz (versus protease inhibitors (PIs)); and NRTI-containing (versus NRTI-sparing). RCTs showed increased subcutaneous fat after switching to NRTI-sparing regimens or from stavudine/zidovudine to abacavir/tenofovir. There were no significant between-group differences in trunk and/or visceral fat gain in RCTs of various regimens, but results from efavirenz versus PI regimens were inconsistent. There was no significant between-group differences in central fat gain in RCTs switched to NRTI-sparing regimens, or from PI-containing regimens.ConclusionsThere is clear evidence of a causal relationship between NRTIs (especially thymidine analogues) and lipoatrophy, with concomitant PIs possibly having an ameliorating effect or efavirenz causing additive toxicity. By contrast, central fat gain appears to be a consequence of treating HIV infection, because it is not different from controls, is not linked to any antiretroviral class, and doesn't improve on switching.
Highlights
Fat redistribution, called lipodystrophy, is frequently observed in patients on long term antiretroviral therapy (ART) [1]
Fat gain, which is widely prevalent in the general population and increases with age, may in part be the result of effective ART reversing fat loss due to HIV infection
It is important to determine whether lipodystrophy is an adverse drug reaction to avoid unnecessary drug substitutions which may result in risks of virologic failure, new toxicities, and undermining patient confidence if the lipodystrophy does not improve
Summary
Called lipodystrophy, is frequently observed in patients on long term antiretroviral therapy (ART) [1]. Central fat gain is assumed to be an adverse drug reaction [4]. Fat gain, which is widely prevalent in the general population and increases with age, may in part be the result of effective ART reversing fat loss due to HIV infection. It is important to determine whether lipodystrophy is an adverse drug reaction to avoid unnecessary drug substitutions which may result in risks of virologic failure, new toxicities, and undermining patient confidence if the lipodystrophy does not improve. Lipoatrophy and/or central fat gain are observed frequently in patients on antiretroviral therapy (ART). Both are assumed to be antiretroviral adverse drug reactions
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