icon-    folder.gif   Conference Reports for NATAP  
  22nd Conference on Retroviruses and
Opportunistic Infections
Seattle Washington Feb 23 - 26, 2015
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Body Composition Changes - ART, Raltegravir
  - 2 studies below following this commentary
from Jules: a further drilling down into the data presented in this study at CROI 2015 "Body Composition Changes after Initiation of Raltegravir or Protease Inhibitors".....http://www.natap.org/2015/CROI/croi_149.htm......much was made of the finding in the study that VAT increased about 30% across all 3 study arms - EFV, RAL & boosted PIs & that this was a large gain after only 96 weeks BUT this slide just below from the presentation shows the large gain was mostly in patients with >100,000 viral load at baseline, and key in this slide is for patients with <100,000 viral load at baseline the VAT gains by percent from their baseline weight was not much, its hard to read exactly but it looks like 5-13% approximately, also to consider we don't know who these patients were that had these VAT increases, were they patients who were skinny to begin with who may have been sick & lost weight & were experiencing a return to health, were they patients that had other factors that might have contributed to fat gain (diabetes, diet, exercise, genetic predisposition); another point to consider is regarding lipoatrophy. Although it was reported from this study that 16-18% of patients experienced >10% fat loss & 6-8% >20% fat loss, these results were not broken out by baseline VL & by baseline weight & BMI, so again we dont know who these patients are, its possible that the greatest fat loss occurred in the patients with factors lending the greatest disposition to experiencing fat loss/lipoatrophy such as they were very skinny to begin with or a low BMI, perhaps they had a bad diet, or some other predispositional factor. These data also reflect on the risks for delaying ART initiation, in this case delaying until viral load is over 100,000, or perhaps with a low CD4 although this study did not look at that factor, increased risk quite a bit for significant increases in VAT/trunk fat.


as well, a study to consider was the SPIRAL Study, now granted this study was different in that patients were switched from A PI regimen to remain on that PI or to raltegravir but
Changes in Body Composition after Switching from Ritonavir-Boosted Protease Inhibitors to Raltegravir in Virologically Suppressed HIV-1-Infected Patients (SPIRAL-LIP sub study)......http://www.natap.org/2011/CROI/croi_142.htm......"Significant increases in visceral fat were seen in the CT-scan with PI/r after 48 weeks, whereas no significant changes were seen in the RAL group"


Metabolic Profiles and Body Composition Changes in Treatment-Naïve HIV-Infected Patients Treated with Raltegravir 400 mg bid-based vs. Efavirenz 600 mg qhs-based Combination Therapy: 96-Week Follow-Up....."at week 96, DEXA showed small gains in body fat in both treatment arms"
Reported by Jules Levin
CROI 2010
E. DeJesus1, C. Cohen2, J. Lennox3, A. Lazzarin4, D. Berger5, B. Jin6, H. Teppler6, B-Y. Nguyen6, R. Leavitt6, P. Sklar6 for the STARTMRK (P021) Investigators
1Orlando Immunology Center, Orlando, FL, USA; 2Community Research Initiative of New England, Boston, MA, USA; 3Emory University, Atlanta, GA, USA; 4University Vita-Salute San Raffaele, Milan, Italy; 5Northstar Medical Center, University of Illinois at Chicago, Chicago, IL, USA; 6Merck Research Labs, North Wales, PA, USA