Rethinking Early Assumptions About AIDS Treatment
HIV is a wily rival, depending upon stealth, camouflage, and surprise to wreak its havoc. Characteristic of the unpredictability of HIV, the latest surprise actually comes out of good news. People living with HIV are living longer. So long, in fact, that attention is now turning to side effects not observed in people who succumbed to AIDS before the advent of effective treatments.
Lipodystrophy, or a change in body fat distribution, is an example of this new environment, where the rules have changed from fighting an acute and deadly illness to managing a chronic disease over a long period of time. Emerging evidence on lipodystrophy from researchers around the world is pushing us to rethink our early assumptions. Observation of fat redistribution in individuals undergoing different approaches to disease management raises new questions: Perhaps these changes in metabolism are caused by the disease itself, perhaps by a particular combination of therapies, perhaps from natural changes in metabolism that accompany growing older, or perhaps from some other cause as yet unknown. So before we hastily recommend therapeutic changes, we must keep to our commitment to provide the best medical care currently available. We must dedicate ourselves to a thorough study of the issue. We must partner with people living with HIV to continue in extending and improving their lives, based on the best information we have. Lipodystrophy, and a systematic understanding of how it arises in individuals, is one part of this comprehensive equation.
A complete understanding of side effects, including lipodystrophy, is still ahead of us. Individuals living with HIV must make choices for their health every day. I would encourage each person to continue HIV therapy to avoid the fatal opportunistic infections that will otherwise develop. Consulting with a physician before changing medications is an essential part of managing a chronic disease.
Dr. Roger Anderson treats patients with HIV in Pittsburgh and western Pennsylvania from seven clinics located throughout the region. He has conducted research in causes and possible treatments for lipodystrophy.