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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.

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