Since protease inhibitors (PI's) were added to the chemical arsenal for fighting HIV, many people living with HIV have been literally snatched from the brink of death. HAART (highly active anti-
There are currently four licensed PI's on the market: nelfinavir (Viracept), indinavir (Crixivan), saquinavir (Inverase, Fortovase), and ritonavir (Norvir) and more are in the pipeline. We have less than three years of actual clinical experience with these drugs. As more people take these drugs for longer periods of time, more data becomes available on their treatment effects (how well they suppress HIV viral load), durability (how long PI-
Lipodystrophy is the medical term for the most prominent of these serious side effects. Lipodystrophy involves the body's abnormal metabolism of fat. Although tales of these unattractive changes have been circulating among PLWA's for years, it wasn't until the Fifth Annual Retrovirus Conference in Chicago this year that data was presented by researchers to other scientists and clinicians. One of these documented changes is an expanding waistline, known as truncal obesity (or "whale-
These abnormalities of fat metabolism are unsightly to those who experience them, and add to the social stigma of being HIV positive. Lipodystrophic changes may also be risk factors for other health problems. Despres, in a review article published in the summer 1998 issue of Canadian Journal of Diabetes Care, surmised that truncal obesity may correlate with a worsening cardiovascular system and an increased probability of developing diabetes mellitus. (It is interesting to note that lipodstrophy among insulin-
The last noticed side effect is an increase in the amount of fat deposited around internal organs, such as the heart, kidney, liver, and pancreas. This puts a strain on these organs and predisposes them to dysfunction. Although these researchers discovered this phenomenon by performing CAT scans on volunteers, Despres's article mentions studies that correlates truncal obesity with increased internal fat deposits.
Although interest in the effects and causes of lipodystrophy is intense, generating many research studies, relatively few are far enough along to have been published in the scientific literature. These studies peg the incidence of lipodystrophy among HIV-
One of the abstracts presented at the Geneva 12th World AIDS Conference detailed a study of 8 men who developed dorsocervical fat pads after initiating PI therapy. Since these "buffalo humps" resemble the changes seen in a syndrome called Cushing's Disease that involves the abnormal metabolism of the cortisol hormones produced by the body, these subjects underwent intense cortisol level testing. Not one of them had the abnormalities associated with Cushing's. The investigator's concluded that abnormal cortisol metabolism did not play a part in these men developing lipodystrophy, but felt that they did not have enough evidence to blame PI's.
Miller, et. al., studied subjects with abdominal symptoms consistent with lipodystrophy via CAT scan, measuring the amount of fat surrounding the abdominal organs. They found a significant difference in the amount of fat in men with lipodystrophy compared to normal controls. Although this is also a hallmark symptom of Cushing's disease, the study discussed above did not support Cushing's as a cause.
These and other published studies underscore the need for more research. Little research has been done on women, for instance, although there is plenty of anecdotal evidence that women also suffer from lipodystrophy. There are no published studies investigating lipodystrophy in children.
The published data to date describe the phenomenon of lipodystrophy in PI users, but none can explain why it is occurring. This is because the phenomenon is a complicated one. Some but not all HIV-
Although lipodystrophy is unsightly and a potential health hazard, most clinicians currently recommend continuing PI therapy, as the risks of discontinuing therapy that is working are known and severe. If you are having signs of lipodystrophy, tell your health care provider. Discuss with him or her methods of reducing blood lipid levels, triglycerides and cholesterol, including drug therapy for extreme cases. (Many lipid-
1. Lo, J.C. et al, "Buffalo Hump in Men with HIV-1 Infection." The Lancet. Vol. 351. March 21, 1998. pp 867-870.
2. Kotler, Donald P. Truncal Obesity, "'Crix Belly' -- Is it what it appears to be...or something else?" Online at www.healthcg.com/hiv/updates/feb98.
3. Letters in Lancet, Vol351, June 6, 1998. "Abnormal fat distribution and use of protease inhibitors." (1) Wurtz, Rebecca. pp 1735-6. (2) TTY Ho, et al. pp 1736-7.
4. Alcorn, Keith. "Lipodystrophy Update." AIDS Treatment Update. Online at www.nam.org.uk/atu/64part2.htm, issue 64, 4/98.
5. Miller, et al. "Visceral abdominal-fat accumulation associated with use of indinavir." The Lancet. Vol 351, March 21, 1998. pp 871-875.
6. Viraben and Aquilina. "Indinavir-
7. Strain, Wm. "Lipodystrophy Cause Unknown." Online at www.apla.org/apla/9803/lipodystrophy.html
8. Baker, Ronald. "Unusual Side Effects Due to HIV Therapy?" BETA July 6, 1998 pp6-7.
9. AIDS Treatment Review #26/27. "Metabolic Problems and PI's." Online at [204.179.69/network/trs 2627.html#meta](http://204.179.69/network/trs 2627.html#meta).
10. Despres, J-P. "Waist circumference as a clinical assessment of viseral obesity, a risk factor for type 2 diabetes and cardiovascular disease." Canadian Journal of Diabetes Care. Vol 22, no. 2 Summer 1998 issue.
Fighting Fat Naturally
Unwanted fat and high cholesterol levels are both a blow to self-
Naturopath Brad Lictenstein has seen an increasing number of patients with alarmingly high cholesterol levels. He reports some of his patients having triglyceride levels 10 to 17 percent higher than normal. This is not only dangerous to the cardiovascular system, putting people at risk for heart disease, but a threat to other organs such as the pancreas and liver.
These two organs can already be overstressed by anti-HIV drugs, and many of the synthetic drugs used to lower cholesterol can compound the problem, because they are toxic to these organs as well. Excess triglycerides accumulate in the liver itself, causing something colorfully known as "fatty liver." Kidding aside, pancreatitis and liver disease are life-
Dr. Lichtenstein recommends following some basic guidelines to help lower cholesterol the natural way. He notes that the suggestions given in the following list do not guarantee lower cholesterol, especially in people with super-
Eat Garlic and Onions: Studies have shown that 4,000 mg of fresh garlic (roughly 1 to 4 cloves) a day lowered cholesterol by 10 to 12 percent. Aged garlic loses some of its potency, but still showed a 7 percent reduction of cholesterol levels. Raw garlic is best because cooking destroys the cholesterol-
Take Niacin, Vitamin B3, or Inositol Hexaniacinate Supplements: All of these have similar properties and work to reduce cholesterol. Inositol hexaniacinate does not produce the hot flashes that the other two nutrients have been known to cause. Recommended dosing of all three is the same: 500 mg three times a day with food for two weeks, then increase to 1,000 mg per day.
Take Gugulipid Supplements: This exotic-
Decrease or Avoid Consumption of Animal Products: They are nature's only source of cholesterol and contain saturated fat.
Eat Fiber: All fruits, vegetables, grains, and legumes aid in digestion and absorb and eliminate fats.
Avoid Caffeine: Decrease or stop drinking caffeinated beverages such as coffee, Coke, and tea.
Stop Smoking: What more can we say?
Exercise: Include both aerobic (to help the cardiovascular system) and anaerobic (to build lean muscle mass) exercise on a regular schedule.