Table 1.
Objective Changes in Central Fat Following Antiretroviral Therapy Initiation and Switch
| Study | Intervention | Subjects (no.) |
Duration (wks) |
Impact on Fat |
|---|---|---|---|---|
| Randomized Trials of Initial Therapy | ||||
| McComsey et al ACTG 5224s [39] |
ATV/r or EFV + ABC/3TC or TDF/FTC | 269 | 96 | Greater increase CT VAT area ATV/r (26%) vs EFV (12%); not statistically significant |
| Martinez et al ATADAR [50] | ATV/r or DRV/r + TDF/FTC | 178 | 96 | Greater increase DXA trunk fat ATV/r vs DRV/r; no significant VAT difference |
| McComsey et al ACTG 5260s [38]. |
RAL, DRV/r or ATV/r + TDF/FTC | 330 | 96 | Similar increase CT VAT area (RAL, 29% DRV/r, 21%; ATV/r, 16%) |
| Moyle et al [49]. CASTLE |
ATV/r or LPV/r + TDF/FTC | 224 | 96 | Greater increase DXA trunk fat ATV/r vs LPV/r; no significant VAT difference |
| Vrouenraets et al [48]. | ATV/r or SQV/r + TDF/FTC | 86 | 48 | Greater increase DXA trunk fat and VAT ATV/r vs SQV/r; not statistically significant |
| Switch Studies | ||||
| Moyle et al [S167] | PI ->EFV | 25 | 52 | CT VAT area decreased 10% |
| Bickel et al PROTRA1 Study [S168] |
PI ->EFV | 23 | 48 | No change CT VAT area |
| Tebas et al [S169] | PI ->NVP | 40 | 24 | No significant body composition changes DXA or MRI subset |
| Moyle et al [S170] | PI ->ABC | 27 | 48 | No change CT VAT area |
| McComsey et al [S171] TARHEEL Study |
d4T -> ABC or AZT |
118 | 48 | CT VAT area decreased 4%; CT SAT area decreased 32% |
| Moyle et al [S172] | d4T or AZT-> TDF or ABC | 105 | 104 | TDF and ABC modest increases DXA SAT; no significant VAT changes |
| Tebas et al [S173] ACTG A5110 |
d4T or AZT-> ABC, LPV/r + NVP or delayed switch |
101 | 48 | Both arms: increased CT SAT area and decreased VAT-to- total fat ratio Switch to ABC reduced CT VAT area |
| Curran et al [S174] SPIRAL-LIP Study |
PI/r ->RAL or continued PI/r | 74 | 48 | RAL: no significant CT VAT or SAT change PI/r: increased CT total abdominal fat and VAT area |
| Lake et al [S175] WI-Fat Study |
PI or NNRTI -> RAL or delayed switch | 37 | 48 | No significant CT SAT or VAT area changes |
| John et al [S176] | d4T or AZT + 3TC + PI -> AZT + 3TC + ABC or continue current |
37 | 48 | Increased DXA SAT; no change in CT VAT area |
| Stanley et al [S177] | LPV/r ->ATV/r | 14 | 24 | Significant decrease in CT VAT area |
Abbreviations: 3TC, lamivudine; ABC, abacavir; ACTG, AIDS Clinical Trials Group; ATV/r, ritonavir-boosted atazanavir; AZT, zidovudine; CT, computed tomography; d4T, stavudine; DRV/r, ritonavir-boosted darunavir; DXA, dual x-ray absorptiometry; EFV, efavirenz; FTC, emtricitabine; LPV/r, ritonavir-boosted lopinavir; MRI, magnetic resonance imaging; NVP, nevirapine; PI/r, ritonavir-boosted protease inhibitor; RAL, raltegravir; SAT, subcutaneous adipose tissue; SQV, saquinavir; TDF, tenofovir disoproxil fumarate; VAT, visceral adipose tissue.