Switch to TDF/FTC from ABC/3TC Lowers Lipids

Are you still conflicted about the choice between the NRTI backbones abacavir/lamivudine (ABC/3TC) and tenofovir/emtricitabine (TDF/FTC)? A recent report will give you more to consider. It has been observed in other studies that patients on TDF/FTC tended to have lower lipid values than those on ABC/3TC. This randomized open label switch study of hyperlipidemic (TC >200 mg/dL) patients (n = 157) on stable suppressive ABC/3TC + efavirenz explored that issue. Half switched to TDF/FTC/EFV (fixed-dose combination). After 12 weeks, the remaining ABC/3TC patients also switched. At week 12, all lipid measures had decreased in the switch group but not in the control group: total cholesterol dropped 33 mg/dL, LDL and triglycerides dropped 17-18 mg/dL, and HDL dropped 6 mg/dL. At week 24, similar changes were seen in the remaining patients switched to TDF/FTC. Authors report no changes in eGFR and no differences between groups in rates of proteinuria.

Reference

Moyle GJ, Orkin C, Fisher M, et al. A Randomized Comparative Trial of Continued Abacavir/Lamivudine plus Efavirenz or Replacement with Efavirenz/Emtricitabine/Tenofovir DF in Hypercholesterolemic HIV-1 Infected Individuals. PLoS One. 2015 Feb 6;10(2):e0116297.

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