If it feels like you are hearing about lipodystrophy a lot lately, there is a reason. Reports are coming in from various HIV/AIDS clinical drug studies that report higher rates of lipodystrophy among their patients than virtually any other drug side effect, or even opportunistic infection. Project Inform of San Francisco announced that 15 percent of their telephone "hotline" calls have been regarding lipodystrophy. I know that in my conversations with co-workers and friends, many of us are living with this in some fashion or another.
The First International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV was held in San Diego last June. While they may not have found the solution yet, they have made quite a few observations. Results from studies involving more than 7,000 HIV+ subjects were presented at the meeting.
While drugs from all three classes may be involved, the protease inhibitors appear to have the strongest effect on metabolic changes and lipodystrophy. Switching from protease inhibitors to non-nucleoside reverse transcriptase inhibitors was shown to partially reverse lipodystrophy in some cases.
Of the other antiretrovirals, Zerit (d4T) was linked to higher rates of lipodystrophy than any other nucleoside or non-nucleoside. According to a report from Harvey S. Bartnof, MD, "all NRTI (nucleoside reverse transcriptase inhibitor) drugs have some degree of associated fat redistribution, either lipoatrophy (fat loss) or fat accumulation, or both. However, the rate with Zerit-containing regimens is 2- to 3-fold higher than other NRTI drugs." Dr. Bartnof goes on to state that not all studies have shown an increased rate associated with Zerit, but that most do, and that in two very small studies, when Zerit was changed or deleted, fat loss improved after six months. Length of time on NRTIs and age also appear to be risk factors for lipodystrophy.
The SALSA Cohort (Self-Ascertained Lipodystrophy Syndrome Assessment) looked at the differences between men and women experiencing lipodystrophy. Though both sexes showed high rates of lipodystrophy, the results were higher among the women. Abdominal fat accumulation (protease paunch) was reported in 98 percent of the women and 76 percent of the men. Fat accumulation on the back of the neck and also fat accumulation in the breasts were both more frequently reported in women. Fat loss under the skin (lipoatrophy) showed the opposite gender effect. More men than women experienced the loss of fat from their faces, arms, legs and buttocks.
Blood fat abnormalities showed to be more common in men than women also in this study. High triglyceride levels were found in 84 percent of the men versus 32 percent of the women. High cholesterol levels were found in 53 percent of the men compared to only 28 percent of the women.
Other trends reported during the meeting included overweight people being more likely to experience fat accumulation, whereas underweight people are more likely to experience fat loss under the skin.
In regards to treatments for fat loss, Abimanu Garg, MD, from the University of Texas Southwestern Medical Center at Dallas discussed cosmetic treatments such as transplanting fat from elsewhere in the body to underneath the facial skin. Dr. Garg indicated that this is only a temporary solution as the transplanted fat is usually reabsorbed over time. He also stated that implants made of silicone or salt water and placed below the facial skin did not seem to have good results, often resulting in unsightly complications, including skin loss over the implant.
For treating blood fat abnormalities, the therapy would be the same as for HIV-negative people. Drugs such as Lipitor are being used with some success in lowering triglyceride levels, and omega-3 fish oil may also be of some benefit.