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Lipodystrophy and WastingLipodystrophy and Wasting
           
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Standard of care for Lypodystrophy/Wasting
Apr 28, 2004

Thanks for your answer of DECA/Testosterone. Just to recap I have been Poz for 12 years with undetectable viral load and T cell at 500 (current meds Kaletra, Viread and Rescriptor). In your reply to my question you indicated that anabolic replacement therapy is not necessarily useful noting the that the risks far outweigh the benfits. I have been exercising consistently for the past 9 months (cardiovascular 30 mins 3X's/Week and resistance weights for 45 mins 3X's/Week) I am not bulking up and in fact am losing weight around my buttocks and legs, this weight is being redistributed to back and stomach. I'd like to know what is the standard of care for managing lypodystrophy? When would someone be considered a good candidate for anabolic therapies? My HMO does not offer Bio Impedance Analysis (BIA) as part of its treatment of HIV, my question is am I being undertreated? and lastly what are your thoughts on a strategic treatment interruption (STI)?

Response from Dr. Moyle

To answer the last one first...STIs are of no benefit to HIV management and a risk if your T cells have been low in the past. Your regimen should not further drive fat loss although fat loss has occasionally been reported even on PI alone therapy. For the type of problems you describe Growth hormone is probably the standard of care (details in a large studies by Kotler et al and Moyle et al in JAIDS 2004 if your doctor needs some references) this tends to reduce fat accumulations and increase buttock mass. However, getting your HMO to offer it may be another thing......

Kind Regards

Graeme Moyle


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