Angiolipoma associated with antiretroviral switch therapy: a case report

TL;DR

A patient developed angiolipomas after switching from one HIV treatment to a newer regimen, suggesting a possible link between the medication change and the condition.

Contribution

This case report highlights a potential association between switching to integrase strand transfer inhibitor-based antiretroviral therapy and the development of angiolipomas.

Findings

A patient developed angiolipomas 19 months after switching from TDF/FTC/EFV to TAF/FTC/BIC.

New lesions continued to appear 29 months after the switch, but no surgical intervention was needed.

The switch to TAF/FTC/BIC may have promoted angiolipoma growth after previously suppressing angiogenesis.

Abstract

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.

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