[Tenofovir as a strategy to avoid or limit adverse effects].

The use of nucleoside analogues, especially that of thymidine analogues, depletes mitochondrial DNA, which is the cause of many of the adverse effects of this family of antiretroviral drugs, among them lipodystrophy. The absence of a specific treatment for lipoatrophy and its direct association with stavudine and zidovudine exposure has led several authors to examine the development of lipoatrophy and of other secondary effects of antiretroviral therapy after substituting a thymidine analogue with tenofovir DF. Prospective observational studies and randomized clinical trials including more than 2000 patients have demonstrated that substituting thymidine with tenofovir increases total body fat, especially in the face and extremities, improves lipid and metabolic profiles in patients, and increases hemoglobin levels when zidovudine is discontinued. These changes are accompanied by maintenance or even an increase of the antiviral and immunological efficacy of antiretroviral therapy. Because of the wealth of scientific data supporting the improvement in lipoatrophy when zidovudine or stavudine are substituted by tenofovir, this strategy can be strongly recommended in antiretroviral therapy.