OBJECTIVE: An antiretroviral regimen based on lamivudine+stavudine+protease inhibitor impairs peripheral fat accrual in HIV-infected children and adolescents. We assess the effect on body composition parameters of replacing stavudine with tenofovir and protease inhibitor with efavirenz in paediatric patients. METHODS: A 96-week prospective study on 24 patients, (age range: 5.0-17.9 years) with stable undetectable HIV-1 loads, who were switched fromstavudine to tenofovir and from protease inhibitor to efavirenz. Patient assessment included: body composition parameters measured by dual-energy X-ray absorptiometry (DXA), viral load and CD4+ T-count and percentage. As a control group for DXA data, we studied 143 healthy controls (HCs; age range: 4.9-20.0 years). RESULTS:Virological suppression and unchanged CD4+ T-cell count and percentage were maintained in all patients. At baseline, patients showed decreased total, arm and leg fat masses (P < 0.01) but a similar trunk fat mass to HCs. From baseline to week 96, patient fat mass increases were comparable to those for HCs (total fat: 1.3 vs 1.2 kg; fat in arms: 0.09 vs 0.08 kg; fat in legs: 0.5 vs 0.5 kg; trunk fat: 0.6 vs 0.6 kg). However, at week 96, total and leg fat mass in patients were still significantly lower than those in HCs (P < 0.02). At baseline and at week 96, lean mass in patients was similar to that expected in HCs. CONCLUSIONS: Replacing stavudine with tenofovir and protease inhibitor with efavirenz for 96 weeks in lipoatrophic paediatrics patients led to a restoration of physiological fat accrual. Lipoatrophy did not progress but was still present, indicating the need for additional strategies.
RCT Entities:
OBJECTIVE: An antiretroviral regimen based on lamivudine+stavudine+protease inhibitor impairs peripheral fat accrual in HIV-infectedchildren and adolescents. We assess the effect on body composition parameters of replacing stavudine with tenofovir and protease inhibitor with efavirenz in paediatric patients. METHODS: A 96-week prospective study on 24 patients, (age range: 5.0-17.9 years) with stable undetectable HIV-1 loads, who were switched from stavudine to tenofovir and from protease inhibitor to efavirenz. Patient assessment included: body composition parameters measured by dual-energy X-ray absorptiometry (DXA), viral load and CD4+ T-count and percentage. As a control group for DXA data, we studied 143 healthy controls (HCs; age range: 4.9-20.0 years). RESULTS: Virological suppression and unchanged CD4+ T-cell count and percentage were maintained in all patients. At baseline, patients showed decreased total, arm and leg fat masses (P < 0.01) but a similar trunk fat mass to HCs. From baseline to week 96, patient fat mass increases were comparable to those for HCs (total fat: 1.3 vs 1.2 kg; fat in arms: 0.09 vs 0.08 kg; fat in legs: 0.5 vs 0.5 kg; trunk fat: 0.6 vs 0.6 kg). However, at week 96, total and leg fat mass in patients were still significantly lower than those in HCs (P < 0.02). At baseline and at week 96, lean mass in patients was similar to that expected in HCs. CONCLUSIONS: Replacing stavudine with tenofovir and protease inhibitor with efavirenz for 96 weeks in lipoatrophic paediatrics patients led to a restoration of physiological fat accrual. Lipoatrophy did not progress but was still present, indicating the need for additional strategies.
Authors: Denise L Jacobson; Kunjal Patel; George K Siberry; Russell B Van Dyke; Linda A DiMeglio; Mitchell E Geffner; Janet S Chen; Elizabeth J McFarland; William Borkowsky; Margarita Silio; Roger A Fielding; Suzanne Siminski; Tracie L Miller Journal: Am J Clin Nutr Date: 2011-11-02 Impact factor: 7.045
Authors: Steve Innes; Eva Schulte-Kemna; Mark F Cotton; Ekkehard Werner Zöllner; Richard Haubrich; Hartwig Klinker; Xiaoying Sun; Sonia Jain; Clair Edson; Margaret van Niekerk; Emily Ryan Innes; Helena Rabie; Sara H Browne Journal: Pediatr Infect Dis J Date: 2013-06 Impact factor: 2.129
Authors: David E Vance; Pariya L Fazeli; Joan E Dodson; Michelle Ackerman; Michele Talley; Susan J Appel Journal: J Neurosci Nurs Date: 2014-10 Impact factor: 1.230
Authors: Grace M Aldrovandi; Jane C Lindsey; Denise L Jacobson; Amanda Zadzilka; Elizabeth Sheeran; Jack Moye; Peggy Borum; William A Meyer; Dana S Hardin; Kathleen Mulligan Journal: AIDS Date: 2009-03-27 Impact factor: 4.177
Authors: C Giaquinto; M Penazzato; R Rosso; S Bernardi; O Rampon; P Nasta; A Ammassari; A Antinori; R Badolato; G Castelli Gattinara; A d'Arminio Monforte; M De Martino; A De Rossi; P Di Gregorio; S Esposito; F Fatuzzo; S Fiore; A Franco; C Gabiano; L Galli; O Genovese; V Giacomet; A Giannattasio; C Gotta; A Guarino; A Martino; F Mazzotta; N Principi; M B Regazzi; P Rossi; R Russo; M Saitta; F Salvini; S Trotta; A Viganò; G Zuccotti; G Carosi Journal: Infection Date: 2010-06-01 Impact factor: 7.455