Angiolipoma associated with antiretroviral switch therapy: a case report

• Published in: AIDS research and therapy 2024-05, Vol.21 (1), p.30-4, Article 30
• Main Authors: Taylor, Gregory H, Pandit, Neha Sheth
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adipocytes; Adipogenesis; AIDS; Angiogenesis; Angiolipoma; Angiolipoma - pathology; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Biopsy; Care and treatment; Case reports; Complications and side effects; Cytokines; Drug Substitution; Drug therapy; Efavirenz; Emtricitabine; Extremities; Fatty liver; Gene expression; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Immune system; Integrase; Integrase inhibitor; Lesions; Liver diseases; Male; Middle Aged; Non-nucleoside reverse transcriptase inhibitors; Nucleoside reverse transcriptase inhibitors; Nucleosides; Patient outcomes; Protease inhibitors; Proteinase inhibitors; RNA-directed DNA polymerase; Signs and symptoms; Switch therapy; Switching; Tenofovir; Tenofovir - therapeutic use; Therapy
• ISSN: 1742-6405; 1742-6405
• DOI: 10.1186/s12981-024-00620-9

Angiolipomas have been well described in patients with HIV exposed to protease inhibitors with possible resolution after switching to non-nucleoside reverse transcriptase inhibitor-based regimens. Resolution of symptoms have occurred with switches to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens; however, little is known regarding the development of angiolipomas when switching from NNRTI- to modern, integrase strand transfer inhibitor-based regimens. We describe a patient who underwent switch therapy from tenofovir disoproxil fumarate/emtricitabine/efavirenz (TDF/FTC/EFV) to tenofovir alafenamide/FTC/bictegravir (TAF/FTC/BIC) who later developed angiolipomas. A 55-year-old male had been on TDF/FTC/EFV for 8 years before switching to TAF/FTC/BIC. Nineteen months after antiretroviral switch, the patient presented with multiple lesions in the upper extremities and abdomen. Diagnostic biopsies revealed non-encapsulated angiolipomas and HHV-8 and non-alcoholic fatty liver disease was ruled out. New lesions continued to appear 29 months after ART switch, after which now lesions appeared and prior lesions remained stable with no increase in size noted. No surgical intervention or change in antiretroviral therapy was needed. Angiogenesis may have been suppressed with TDF/FTC/EFV treatment, however when switched to TAF/FTC/BIC, promoted the growth of angiolipomas. Clinicians should be aware of the impact of switching to modern ART therapies resulting in possible adipogenesis.