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lowest potential meds for lipo side effects

Dec 14, 2012

I'm soon to start meds and would like to know what meds, or combos, carry the least risk of lipo. A quad? or Isentress and Truvada This is very hard to figure out.

Response from Dr. Pierone

Hello, and thanks for posting.

You are correct; this is very hard to figure out. One reason is that lipoatrophy has been linked to nucleoside reverse transcriptase inhibitors, especially the older ones AZT (zidovudine, Retrovir), ddI (didanosine, Videx), and d4T (stavudine, Zerit). We don't use these medications much anymore, but still do use the nucleoside and nucleotide class of medications (mostly Truvada, but some Epzicom as well). Although there is less lipoatrophy observed in trials of these newer medications, it may still develop, perhaps at a slower rate.

The current DHHS guidelines for antiretroviral treatment have many different choices available for initiation of therapy. What these options all share in common is that they all contain 2 nukes. There appears to be no significant difference in the rate of lipoatrophy based on what these nukes are combined with. Studies have shown similar rates of lipoatrophy with Isentress, Sustiva, Complera (rilpivirene) and Quad (elvitregravir).

One difference is that when nukes are combined with protease inhibitors, there is some evidence that there may be a lower risk of lipoatrophy. However, this may related to the tendency for protease inhibitors to promote fat accumulation. The worry is that some of this fat is visceral fat, inside the abdomen, and this process increases the risk of diabetes mellitus and cardiovascular disease.

An intriguing possibility is that antiretroviral regimens that do not contain nukes may have the lowest risk of lipoatrophy, but we do not have studies to prove this.

In summary, all of the currently recommended regimens confer a low risk of developing lipoatrophy, so they are all fine. Ongoing and future studies will better define how best to use antiretroviral therapy to limit the risk of this complication.

Stay tuned!

Lipoatrophy on Trizivir and Sustiva

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