Nov 18, 2007
does combivir and aluvia cause lipodystrophy
Response from Dr. Young
Thank you for your post from outside the US.
First, let's be clear that there are factors other than medications that are also drivers of risk of developing lipodystrophy. Having a low CD4 count (ie, waiting too long to start medications) is the most important to recognize. In the CDC HOPS study, patients who start with CD4s below 200 are about 2 times more likely to develop lipoatrophy than those who start at 201-350 cells.
OK, recent data from the ACTG 5142 clinical study gives us a very good insight into your specific question and regimen. 5142 was a head-to-head comparison of different nuke backbones with either lopinavir/ritonavir (Aluvia, Kaletra) or efavirenz (Stocrin, Sustiva). The strength of this study was its size and the fact that the study wasn't conducted by the drug companies who make the various products.
Aluvia was associated with about 1/2 the rates of lipodystrophy than patients who received efavirenz (Stocrin, Sustiva). In the study, 16% of patients who received first-line treatment with AZT/3TC (Combivir) with lopinavir/ritonavir developed lipoatrophy after 96 weeks. Patients who recieved tenofovir (Viread, Truvada) with lopinavir/ritonavir had the lowest rates of lipo in the study- about 6%. Just for comparison, the very popular (and popularly held "lipodystrophy-free") regimen of tenofovir+3TC+efavirenz caused lipo in 12% of individuals.
Hope this is helpful. BY
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