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Effects of Raltegravir (RAL) Combined with Tenofovir (TDF) and
Emtricitabine (FTC) on Body Shape, Bone Density and Lipids in
HIV+ African-Americans Initiating Therapy: Metabolic Outcomes of
The UNC-REAL Study
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Reported by Jules Levin
IAC July 2012 Wash DC
DA Wohl1, L Young1, WB Hyslop1, S Blevins1, D Ragan1, K Walsh1, M Floris-Moore1, A Wilkins2, H Ekis1, YZ Lee1, & JJ Eron1
1The University of North Carolina, Chapel Hill, NC, USA and 2Wake Forest University Health Sciences
wohl@med.unc.edu
Excerpt regarding this study from NATAP IAC Metabolics/Inflammation Report written by David Wohl MD:
A separate study conducted at UNC examined the effects of a different regimen on body shape (2). Raltegravir combined with tenofovir/emtricitabine was administered to 30 African-American men and women initiating HIV therapy. In this study the mean BMI was high at 28. Again CT and DEXA were used to assess body shape changes over 2 years. Here, fat in all regions (visceral, limb, trunk) increased significantly over time. Lipid and insulin parameters did not significantly change; bone density fell slightly. The generalized fat gain seen also in this study further supports a 'return to health profile' rather than a dysmorphic preferential accumulation of belly fat after initiation of HIV therapy with this regimen in African-Americans.
In reconciling these results we can look to what is common among them. Foremost, fat gains appear to be proportional, with increases in fat in multiple depots. Lipoatrophy, fat loss, was not observed and truly does appear to be rare in the absence of thymidine analogues. CASTLE, like several older studies, suggests that those who start thin gain more fat than those who start heavier. This makes sense intuitively (as those who are sicker would be expected to experience a recovery that is accompanied by weight gain). In the UNC study, we found even those who were in no way underweight gained fat after starting HIV therapy. However, subgroups analyses such as those conducted in the CASTLE analysis were not done as the sample size was small and it is possible that those at the lower end of the BMI spectrum drove gains in fat. Overall, the work presented indicates that with ART comes fat and that this is probably mostly accounted for by a redirection of calories previously spent fighting a losing battle against a virus that replicates mercilessly.
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