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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000205
Basic and Translational Science

A 48-Week Study of Fat Molecular Alterations in HIV Naive Patients Starting Tenofovir/Emtricitabine With Lopinavir/Ritonavir or Efavirenz

Domingo, Pere MD, PhD*; Gutierrez, Maria del Mar MD*; Gallego-Escuredo, José Miguel PhD†,‡; Torres, Ferran MD, PhD§; Mateo, Maria Gracia MD*; Villarroya, Joan MD, PhD*,†,‡; Lamarca, Karuna MD*; Domingo, Joan Carles PhD†,‡; Vidal, Francesc MD, PhD; Villarroya, Francesc PhD†,‡; Giralt, Marta PhD†,‡

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Abstract

Background: Conflicting reports on the effects of efavirenz (EFV) and lopinavir/ritonavir (LPV/r) on subcutaneous adipose tissue (SAT) have been described.

Objective: The aim was to assess the 48-week molecular and clinical effects of LPV/r and EFV, combined with tenofovir/emtricitabine (TDF/FTC), on SAT of HIV-infected, antiretroviral-naive patients.

Methods: Forty-four adults were started on LPV/r or EFV combined with TDF/FTC. Fasting metabolic tests, HIV RNA, CD4 cell count, and fat measured by dual x-ray absorptiometry scans were obtained at study entry and week 48. Mitochondrial DNA (mtDNA) and transcripts for mtDNA-encoded proteins and genes involved in inflammation, adipocyte differentiation, and metabolism were assessed in paired SAT biopsies.

Results: Whole-body fat and limb fat mass increased in the LPV/r and EFV groups. MtDNA and cytochrome oxidase subunit II did not change, and cytochrome b increased significantly in EFV-treated patients. Tumor necrosis factor alpha and monocyte chemotactic protein-1 gene expression did not change in the LPV/r group, but these significantly increased in the EFV group. Interleukin 18 decreased in the LPV/r group, whereas it increased in the EFV group.

Conclusions: Starting TDF/FTC plus EFV was associated with an increased expression of genes encoding for inflammatory cytokines in SAT in naive patients. Therapy with TDF/FTC plus LPV/r or EFV was associated with an increase in subcutaneous fat mass.

© 2014 by Lippincott Williams & Wilkins

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