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Standard of care for Lypodystrophy/Wasting
Jun 25, 2004

I have been Poz for 12 years with undetectable viral load and T cell at 500 (current meds Kaletra, Viread and Rescriptor). 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. Henry

Great questions which will expose our lack of knowledge about the underlying causes of lipodystrophy in the setting of treated HIV. Anabolic steroids are not a part of the accepted standard of care for lipodystrophy. Increase body fat is occuring in the general population so it is tough to sort out the contributions of aging, long term HIV survival, and specific drugs. Avoiding drugs with higher association with lipoatrophy (such as D4T) is a preventative approach (or switching off them to drug with perhaps lower risk such as abacavir or tenofovir). Growth hormone, testosterone, diabetes drugs--all have been tried and are under study for the treatment of various aspects of lipodystrophy. So far nothing works consistently so there is no standard of care really treatment wise. An STI is not a good idea if a person previously has had AIDS or a CD4 count < 200 in most cases. If the CD4 count has never been < 350 and there have been no HIV related clinical problems then an STI is something to consider. KH

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