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Do we know enough about lipodystrophy?
Aug 26, 2008

Dear Nelson,

I have a quick question that I feel you can best answer for being an hiv survivor for 25 years. Is the the war on lipo able to be won??? I mean will working out bring muscle back or will my time be wasted??? Also what supplements do you suggest a person take??? I am taking the mv k-pax single strength. Thank You

Response from Mr. Vergel

I would asnwer: "yes, partially"

We now know that a lot that we did not know a few years ago.

1- D4T and AZT are two drugs that are linked to fat loss under the skin (lipoatrophy). Tenofovir (Viread) does not cause lipoatrophy in most patients (only 11% had a loss of 20% or more of fat under the skin when used they used tenofovir/3TC with Kaletra or Sustiva in one study)

2- That some protease inhibitors can negatively affect the job of insulin to help store glucose in muscle as glycogen ( insulin resistance) which may increase triglycerides and fat cell size in some patients

3- We know that exercise helps to build lean body mass

4- we know that anabolic steroids like nandrolone and oxandrolone can help those having a difficut at regaining normal weight

5- Statins and fibrates work at reducing lipids in poz people but sometimes not good enough to have them reach normal levels

6- That supplements like Omega 3 fish oils and niacin can help statins and fibrates improve their job at lowering LDL, triglycerides and increasing good cholesterol (HDL)

7- That those who start HAART with low CD4 cells tend to be more prone to having increased belly fat when their CD4 cells increase

8- That there are products like Sculptra, Silikon 1000 and Radiesse in the United States that can help people restore a healthy face

9- That supplements like K PAX and others have some promising but limited data in HIV that requires more studies

10- That growth hormone (Serostim) works at reducing visceral fat but we cannot use it for lipodystrophy because the FDA did not like growth hormone's side effects. Another less effective but lower side effect product may be approved in the future

11- That switching first line patients from Kaletra to Reyataz does not improve their bodies. Other "switch" studies showed the same results.

Unfortunately, we do not data on lower glycemic index diets, good comparison data of what happens to visceral fat when different protease inhibitors or non-nucleosides are used with Truvada in naives with low and higher CD4 at baseline, diet/exercise combinations, and other supplements like carnitine and others. Stay tuned for my upcoming review of studies to be presented at the Lipodystrophy Conference in London on Nov 2008.

You can read more about where we are now here:

http://www.thebody.com/content/art45454.html

I hope this helped

And yes, single strength K PAX is great as a supplement since it includes all minerals and antioxidants you need.

Nelson



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