The Body Covers: The 3rd International Conference on Nutrition and HIV Infection
Opening Session: The Changing Face of Malnutrition and HIV
April 22-25, 1999
The opening session was devoted to an update on HAART and an update on the changing face of malnutrition in HIV infection. Dr. Donald Kotler of New York presented the latter. Dr. Kotler stressed how far this field has come in 15 years. In 1984 we were just learning the extent of AIDS wasting and the role of body composition studies in its analysis. Now we have a much-improved understanding of this process even as the process itself has changed: less severe wasting with availability of both preventive and therapeutic interventions. Since 1997 awareness has developed of a syndrome of fat redistribution (FRS) associated with the development of unsightly and possibly unhealthy fat deposits, fat wasting in other locations, high levels of blood lipids and even diabetes. Dr. Kotler does not believe that these complications are directly related to protease inhibitor therapy as all have been reported in patients on non-PI containing regimens and even in some without any antiretroviral therapy. Indeed fat redistribution syndrome may actually correlate with an improved prognosis, namely longer survival. Dr. Kotler does not believe that the hypothesis of Carr and Cooper (from Australia) is correct, that the protease inhibitors directly affect a cellular enzyme involved in lipid metabolism. At this point explaining the mechanism behind fat redistribution syndrome is not possible.
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