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Lipodystrophy and WastingLipodystrophy and Wasting
           
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Lipodystrophy risk with med regimen, future expectations, habit change suggestions
May 28, 2003

I'm 34, 6 months diagnosed and on meds (Sustiva, Epivir, Viread) & Androgel (to combat my lower sex drive and energy level -- I had mid-normal Testo level pre-Andro, but sure won't give it up now, benefits way too positive) -- my VL is basically undetectable, T's in the 700's, and I'm very healthy feeling, etc. I realize there are so many factors known and unknown that determine a person's potential risk for developing lipodystrophy, including lifestyle, eating habits and medication combination. I was a moderately heavy pre-teenager and lost and have controlled my weight (now 6'1, 175-80) since age 15 through eating correctly and sensibly. My luck has been that I've maintained a nice physique throughout my life, with moderate amounts of normal exercise (stairs instead of the escalator, a bit of working out, etc.) in addition to the above, and I want to keep it that way. I tolerate all my meds very well and I feel great, but I have questions. The info. that I find on lipodystrophy is so conflicting, if not nonexistent, as far as risk factors and prevention suggestions (aside from being downright scary). Ballpark answers to any unknowns in my questions would still be welcome, and here they are: 1. Is my med combination considered low or high risk for lipo? 2. Is starting meds before becoming symptomatic, or after, or length of viral med usage a factor? (I was asymptomatic and started meds early, VL 80,000 T's 512 when starting) 3. Aside from the benefits I now feel from Androgel, do hormone levels/replacement play a role here? 4. Does age play a role? 5. Is there a certain body type, or a person's tendency to gain or lose weight more easily than others that puts them at higher risk for lipo? 6. Dietary intake - just eat normal? or Low fat/no fat? High protein? No protein? High carbs? No carbs? -- I've heard it all, what do you think? and 7. Dietary supplement suggestions or benefits? So, what's the latest on the best strategy to lessen the probability or severity of developing lipodystrophy -- and the most important reason for writing this (and so others can read!) --- what's the true statistics and likelihood that someone in my situation (age, health, meds., etc.) will have to deal with body changes or lipo D??

Thank you so much --

M.R.

Response from Dr. Moyle

1. Low risk, stick with it (Evidence Gilead 903 study) 2. Starting 'early' appears best. Early may mean any CD4>350 (Evidence HOPS study Lichtenstein JAIDS 2003) 3. Avoid high (above normal range) levels of testosterone as this may strip fat in exchange for muscle. Androgel is the best (most physiologic) supplement. 4. Age over 40 has been associated with a higher risk of lipoatrophy and fat accumulation 5. Very lean people may be the ones in whom lipoatrophy becomes evident most rapidly 6. Just eat normal. Some folks would say a mediterranean diet may be best (30% fats with unsaturated and omega 3s tha main fats, fruit and veges and fibre). The evidence is only there for this diet in heart disease prevention. 7. No clear data on supplements but some folks use acetyl-L-Carnitine, co-Q-10 (ubiquinone), riboflavin.....the rule here is don't overburden yourself with unproven products and complicate your therapy. 8. On your regimen in Gilead 903, <1% of people had lipodystrophy reported by their doctor after 96 weeks treatment. It is higher in the d4T arm of the study (12% at 96 weeks). Genetic characteristics also play a role in risk.

Hope this helps

Graeme


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