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CROI: Kaletra vs efavirenz and lipoatrophy

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Cerrid:
"Lopinavir/ritonavir (Kaletra) was less likely to cause fat loss (lipoatrophy) than efavirenz (Sustiva) when paired with nucleoside analogues, analysis of the ACTG 5142 study has shown. The findings, presented on Monday at the Fourteenth Conference on Retroviruses and Opportunistic Infections in Los Angeles, show that while efavirenz suppressed viral load for longer, those who took the drug were almost twice as likely to experience fat loss in the face or limbs compared to those who took Kaletra.
 
 A second study, of lopinavir/ritonavir maintenance monotherapy, also found that when compared to patients treated with efavirenz, AZT and 3TC, those who received Kaletra monotherapy were much less likely to lose limb fat after two years of treatment."
 
http://www.aidsmap.com/en/news/D412C57E-5683-415D-B807-04E69DE1AABF.asp

Ihavehope:
Not sure about this, but I guess Kaletra has some advantages after all.

Ihavehope:
The % oif people suffering from lipo on sustive compared to Kaletra is quite significant. I wonder how this can impact the choice of what regimen doctors will recommend their patients will be on. As far as I am concerned. Atripla which contains sustiva is the most popular.

blondbeauty:
But the group experiencing less lipoatrophy was using a combo containing EFAVIRENZ! "Lipoatrophy, defined as a 20% loss of limb fat at week 96, was experienced by 32% of the efavirenz + 2NRTI group, 17% of the Kaletra + 2 NRTI group, and 9% of the Kaletra/efavirenz group." And the groups with more lipoatrophy were the ones taking D4T or AZT.
I think the important result of this study is that only 9% of the patients taking a regime with efavirenz had lipoatrophy and the group of 2NTR + Kaletra had a 17% of patients suffering from lipoatrophy.
So I dont really think the title of the article matches the results and that the main cause of lipoatrophy are still AZT and D4T.
Can Kaletra +Sustiva be used as a complete combo?

Cerrid:

--- Quote from: blondbeauty on March 05, 2007, 10:22:50 AM ---Can Kaletra +Sustiva be used as a complete combo?

--- End quote ---

I don't think so, it looks more like an experimental combo than a clinical practice combo. The recommended combos consist of 2 NRTI + 1 PI OR 2 NRTI + 1 NNRTI.

The NRTI-free combo Kaletra/Sustiva was only used in this study as reference to monitor the lipo-effect of an NRTI-free combo. Of course, you're right about your remarks on the choice of AZT and D4T as NRTI for this study. They both make a major contribution on LD. But still, the Sustiva arm has a higher incidence of LD than the Kaletra arm when combined with these NRTI.

Here's another summary of this study. Well, actually of the two studies:
http://www.aidsmeds.com/articles/1961_11394.shtml

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