Facial fat loss improves after switch to abacavir or tenofovir

Facial fat loss caused by treatment with AZT or d4T is improved 48 weeks after switching to abacavir or tenofovir, Dr Paul Benn of London’s Mortimer Market Centre confirmed on Monday at the Seventh International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, in Dublin, Ireland

Dr Benn was reporting results of the lipoatrophy substudy of RAVE, a UK study that looked at the effect of dropping AZT or d4T and replacing the drug with abacavir or tenofovir in people with undetectable viral load.

The study recruited 47 patients (23 assigned to tenofovir, 24 to abacavir), and used a laser imaging technique to map the contours of the face, in order to detect restoration of fat in the cheeks and forehead. Although the presence of facial fat loss was not a condition of entry into the study, 84% of participants reported lipoatrophy. More than two thirds or patients in each arm had been taking d4T previously.

After 48 weeks on the new regimen, laser imaging reported improvements (or no further deterioration) in cheek fat in 68% of participants, although only one-third of participants told their doctor that their facial fat loss had improved during this time.

The improvements in cheek fat were significant, but no change in fat at the temples/forehead area was noted. The mean volume increase in cheek fat was similar to the increase in cheek volume seen in a control group of patients who received collagen injections in order to improve facial lipoatrophy,

The changes in facial fat correlated well with improvements in limb fat as measured by DEXA scan (p=0.02), although the amount of limb fat gained after 48 weeks was considerably smaller than the limb fat gain seen in the study of Nucleomaxx supplementation (also presented on Monday at the Workshop). Participants in the tenofovir group gained a median of 390g of limb fat, compared to 300g in the abacavir group. This difference was not significant.