Evidence that facial fat can return after switching from either d4T or AZT, to abacavir or tenofovir

Simon Collins, HIV i-Base

Although it is now well established that switching from a thymidine analogue to either abacavir or tenofovir can slowly reverse limb fat loss improvements in facial lipoatrophy have not been clearly established. [1, 2, 3]

Paul Benn and colleagues reported results from using 3D facial imaging to measure changes in facial volume over 48-weeks, in a sub-study of 47 patients enrolled in a UK switch study (RAVE). [4] All patients were virologically suppressed (11 on AZT and 36 on d4T) prior to switching to abacavir (n=24) and tenofovir (n=23). At baseline 39/47 patients in the sub-study (85%) reported facial lipoatrophy with 32/47 (68%) reporting either no worsening, or a perceived improvement in facial lipoatrophy at week 48.

Mean volume difference in both cheek areas at week 48 was +2539mm3 (SD 5346) (just over 1cm3 in each cheek) although fat in forehead area decreased by -138mm3 (SD 347) over the same period. Mean limb fat, measured by DEXA, also increased by 2.9kg (SD 0.9) and 3.4 kg (SD 2.1) in the abacavir and tenofovir groups respectively. There was a correlation between increases in cheek fat and limb fat that remained significant after adjusting for weight gain (p=0.02) but there were no statistically significant differences between the abacavir and tenofovir arms.


  1. Moyle GJ, Baldwin C, Langroudi B et al. A 48-week, randomised, open-label comparison of three abacavir-based substitution approaches in the management of dyslipidaemia and peripheral lipoatrophy. Journal of Acquired Immune Deficiency Syndromes May 1, 2003; 33(1):22-28.
  2. Carr A, Martin A, Ringland C et al – Long term changes in lipodystrophy after switching from thymidine nucleoside analogues to abacavir. Programme and abstracts from the 5th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 8-11 July 2003, Paris Abstract 16.
  3. Moyle G et al. A randomised, open-label comparative trial of abacavir or tenofovir DF as replacement for a thymidine analogue in persons with lipoatrophy and suppressed HIV RNA on HAART. 12th Conference on Retroviruses and Opportunistic Infections (CROI), Feb 22-25, 2005, Boston, Abstract 44LB.
  4. Benn P, Sauret V, Cartledge J et al. Improvements in facial lipoatrophy at 48 weeks following substitution of a thymidine analogue with tenofovir (TDF) or abacavir (ABC): a randomised, open-label study in people with lipoatrophy and virological suppression on HAART. 7th Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 13-16 November 2005, Dublin. Abstract 8.

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