Lipodystrophy: Serious Treatment Side Effect
In addition to physical changes, lipodystrophy affects the body's ability to process and distribute glucose and lipids (fats). Diagnosed through blood tests, these metabolic abnormalities can be very serious:
In addition, the importance of preventing the physical changes associated with lipodystrophy should not be taken lightly. Abnormal fat distribution can lead to loss of self-esteem and depression, which are leading causes of non-adherence to the complex and demanding treatment regimens of highly active antiretroviral therapy (HAART). Non-adherence can lessen the effectiveness of HAART and also encourage the development of drug-resistant HIV strains. In addition, as the physical changes that signal lipodystrophy become more widely known,many people may become exposed to the AIDS-related discrimination that can result from a loss of confidentiality regarding one's HIV status.
We still know very little about this disturbing syndrome among people with HIV/AIDS:
Doctors do not yet agree on which of the physical and metabolic changes associated with lipodystrophy are most significant or how to precisely measure them. The various symptoms of lipodystrophy are not always linked, and we do not know whether they become more severe over time. Not surprisingly, the lack of a standard case definition has complicated efforts to diagnose and track lipodystrophy, and estimates of its incidence range widely -- from as low as 5% to as high as 78% of long-time survivors of HIV/AIDS.
With no clear definition or uniform diagnostic criteria, it is difficult for scientists to identify the cause of lipodystrophy. Associations have been suggested with various antiretroviral drugs, but no direct causal relationships have been proven.
There is an emerging consensus that the cause of lipodystrophy is multifactorial, and current data support a role for protease inhibitors, NRTIs, and other factors. In fact, what we currently understand as a single syndrome may actually be two or more overlapping syndromes, each with its own causes and needed treatments.
It is obviously difficult to treat a condition that is poorly defined and for which the cause is unknown. Current remedies focus on specific symptoms of lipodystrophy and include:
It is also important to note that, while lipodystrophy may be linked to antiviral therapy, the benefits of anti-HIV treatment still clearly outweigh the risks for most patients. Virtually all medications have side effects, and the anti-retrovirals implicated in lipodystrophy are extending life for many thousands of people with HIV/AIDS. Ultimately, lipodystrophy may prove to be an unavoidable cost of long-term success with anti-HIV therapy.
So what should individuals experiencing symptoms of lipodystrophy do?
Lipodystrophy is now receiving attention from both HIV/AIDS advocates and researchers, and there is good reason to hope that we will soon have a better understanding of this troubling syndrome. The American Foundation for AIDS Research (amfAR) is committed to keeping both people with HIV/AIDS and health care professionals well-informed about lipodystrophy and recently sponsored a series of nationwide community forums that outlined several priorities for further study in this area, including:
amfAR continues to support basic biomedical research on HIV/AIDS that may help answer some of these questions. In February 2000, the Foundation released a major new request for proposals in all areas of basic HIV/AIDS research and hopes to fund new projects related to lipodystrophy and other treatment complications.
This article was provided by amfAR, The Foundation for AIDS Research. Visit amfAR's website to find out more about their activities and publications.