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Fat Problems Challenge HIV Treatment

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Feb. 27, 2002 -- For people with HIV infection, it's a terrible catch-22. You suffer if you don't take your HIV drugs. You may also suffer if you do.

Without modern medicine, getting HIV means you will get AIDS and die. It's far better to take the drugs -- when needed -- than to take your chances. The drugs don't cure HIV. That means you have to take them, day in and day out, for the rest of your life.

Potent AIDS drugs have only been around for a few years. This means that their long-term side effects are only beginning to appear. One of these long-term effects became apparent in 1998. It's called lipodystrophy or fat redistribution syndrome (FRS). It means that the drugs somehow throw a monkey wrench into the way the body deals with lipids -- fats -- and cholesterol. This has dramatic effects -- although not as dramatic or deadly as AIDS.

"These [fat]-related problems are probably the greatest challenge we have right now in treating patients. ... It is a tremendous problem for our patients," says AIDS specialist Howard A. Grossman, MD.

Grossman has a large HIV/AIDS practice and teaches medicine at Columbia University. He spoke at a recent news conference along with Princy N. Kumar, MD, chief of the department of infectious diseases at Georgetown University. GlaxoSmithKline -- which finances an institute for the study of metabolic disorders linked to AIDS drugs -- sponsored the news conference.

Patients who suffer from FRS have a gaunt look -- they lose fat from their face, arms, and legs. They gain fat on the back of the neck in what's come to be called a buffalo hump. Women, in particular, suffer from painful fat gain in the breasts. And fat piles up around internal organs as well.

It's not just a cosmetic problem. Extra fats in the blood make the body try to adjust -- beginning the same process seen in people who get type 2 diabetes. In fact, diabetes is one of the risks from long-term use of AIDS drugs. Cholesterol levels also get high -- so high that most AIDS doctors think they'll be seeing a lot of heart disease if they don't do something.

"We feel that as the years go by we are going to see more and more [heart] disease," Kumar says. "We are looking at patients to see what are their risks of heart disease. And then we more aggressively are using [cholesterol]-lowering agents. All of us first try exercise and diet, but in the majority of patients it doesn't work. Up to 50% will need [cholesterol]-lowering agents. This is much more difficult than in non-HIV patients because these drugs have important interactions with anti-HIV drugs."

People don't just take one anti-HIV drug. They take combinations, commonly known as drug cocktails. This works great against the AIDS virus, but it's made it hard to tell which drugs cause which long-term side effects. Now some trends are beginning to appear.

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