May #47 : The Skinny on Lipo - by Linda Grinberg

POZ - Health, Life and HIV
Subscribe to:
POZ magazine
E-newsletters
Join POZ: Facebook MySpace Twitter Pinterest
Tumblr Google+ Flickr MySpace
POZ Personals
Sign In / Join
Username:
Password:

Back to home » Archives » POZ Magazine issues




Table of Contents

A POZ Family Album

POZ 5TH Anniversary Issue: Year One

POZ 5TH Anniversary Issue: Year Two

POZ 5TH Anniversary Issue: Year Three

POZ 5TH Anniversary Issue: Year Four

POZ 5TH Anniversary Issue: Year Five

POZ 5TH Anniversary Issue: Profiles

The Way We Live Now

The Way We Live Now: Andrew Sullivan

The Way We Live Now: Jocelyn Elders

The Way We Live Now: Mary Lucey

The Way We Live Now: Rafael Campo

The Way We Live Now: Mathilde Krim

The Way We Live Now: Mario Cooper

The Way We Live Now: Richard Goldstein

The Way We Live Now: Phill Wilson

The Way We Live Now: Michael Saag

The Way We Live Now: David Ho

The Way We Live Now: Jon Kaiser

The Way We Live Now: Sarah Schulman

The Way We Live Now: Judy Greenspan

The Way We Live Now: Eric Rofes & Dan Savage

The Way We Live Now: Kaiya Montaocean

The Way We Live Now: Ashok Row Kavi

The Way We Live Now: Pat Califia

The Way We Live Now: Asia Russell & Julie Davids

The Way We Live Now: Dennis DeLeon

The Way We Live Now: Jason Farrell

The Way We Live Now: Pernessa Seele

Honeymoon to HAARTache

Monkey Business

S.O.S.

When Plagues Return

To the Editor

School Ties

The Bottom Line

Up Close & Personal

Say What

Two Peas in a POZ

In Cold Blood

Oops!

Rubber Poll

Poster of the Month

Success Has Made a Failure of Us

POZarazzi: The Bod Squad

Saint Sorge

Obits

Anecdotal Antidotes

Get Over It

Rubdown Lowdown

The Berlin Stories

T-20, Coming to a Combo Near You

Pill Drill

Suck in Your Gut

Put the Gart Before the Course

Where to Find It

The Skinny on Lipo

HAART Chart

The Road to Wellville

IN MEMORIAM



Most Popular Lessons

The HIV Life Cycle

Shingles

Herpes Simplex Virus

Syphilis & Neurosyphilis

Treatments for Opportunistic Infections (OIs)

What is AIDS & HIV?

Hepatitis & HIV


email print

May 1999

The Skinny on Lipo

by Linda Grinberg

Treatment options for fat-gone-haywire

For growing numbers of PWAs, enthusiasm for protease inhibitors is waning, due to increasingly intolerable side effects (see “Honeymoon to HAARTache"). Thrown on the horns of a terrible dilemma—grappling with whether to risk viral rebound by stopping treatment or switching to protease-sparing regimens that may not provide long-term viral suppression—disheartened PWAs are often guiltily missing doses and failure rates are climbing. Piled atop a litany of other side effects, lipodystrophy has become, for some, the last straw. “One of my greatest fears is that I’ll have a general system failure due to the drugs,” says Sean Casey Venable, a PWA in Lewes, Delaware. “I told my doc I wasn’t sure how much longer I could live this way. I might discontinue all therapy and let the disease take its course. I’m going to think about it some more.”

In the face of growing problems with side effects, adherence and viral resistance, some researchers are questioning the “hit early, hit hard” gospel. “We are doing a lot of opinion-based medicine and need more evidence-based medicine,” says Australian researcher David Cooper, MD. He suggests we revisit bedrock assumptions, noting that the decline in U.S. death rates has paralleled that of Britain, where the standard of care is to delay treatment for asymptomatic patients with high CD4 counts and stable viral loads. He cautions that it is unclear whether the rates will remain similar over time. “There is no question that the risk/benefit favors PIs in symptomatic disease,” Cooper says. “In asymptomatic infection the benefit is not known and protease-sparing regimens might be considered, but I’m reluctant to switch anybody at the present time.” Martin Delaney of Project Inform concurs. “So far there is only inconsistent anecdotal evidence as to whether switching therapy helps combat lipodystrophy,” he says. “Even less is known about the relative risks and benefits of taking extended drug holidays.”

The good news is, there may be several potential treatments to alleviate lipodystrophy-related problems such as altered body shape, increased blood sugar and elevated lipids (cholesterol and triglycerides). Lipid-lowering drugs, such as Lipitor, may help, but they have yielded inconsistent results in studies of PWAs, and can cause neuropathy. Liposuction may offer temporary improvement for buffalo hump. But removal of visceral fat, deep in the abdominal cavity, is highly risky as it can cause hemorrhaging.

Data from small studies of human growth hormone (HGH) show partial improvements in buffalo humps and abdominal fat. Unfortunately, the $20,000 to $30,000 annual price tag may put the drug out of reach for many. Because HGH has been approved only for HIV wasting, it may not be covered for lipodystrophy under some insurance plans. (However, some PWAs have successfully used their wasted limbs to justify coverage.) Serono, the manufacturer of Serostim, has an ambitious research agenda to assess the drug’s usefulness for treating lipodystrophy.

The diabetic medication Metformin may also hold promise. A recent preliminary report, based on an eight-week study in 21 PI-experienced patients with central obesity, showed decreases in waist-to-hip ratios, triglycerides and insulin levels. Metformin may ultimately prove to be a relatively inexpensive treatment, though not without its potential side effects.

Preliminary research indicates that the benefit of exercise and diet is modest, at best. Neither appears to have a measurable impact on deep visceral fat or elevated lipids, though both may reduce superficial fat, unrelated to lipodystrophy. Diet, exercise and weight training help tone and build muscle tissue, which, in turn, may improve the appearance of truncal obesity and wasting in the limbs. For patients at risk for cardiovascular disease and diabetes, smoke cessation, aerobic exercise and lowered sugar and fat intake are recommended. However, before beginning any new regimen, it is advisable to consult with your health care provider. Some PWAs are experimenting with various combinations of vitamins, minerals and amino acids—but without controlled data, their utility remains unclear (see “Take That, Fat!,” POZ, October 1998). Until there is a coordinated research agenda, those affected will continue casting about in the dark, sharing anecdotal experiences and guessing.


FAT CHAT

For those taking protease combos, two e-mail lists offer a forum to share experiences and hash out problems about everything from drug choices and dosages to side effects and their remedies:

LIPIDLIST, set up by ACT UP/ Golden Gate, welcomes discussion of PWAs’ metabolic problems. To subscribe, send an e-mail to listproc@critpath.org. In the first line, type “subscribe lipidlist” and then your first and last name.

PI-TREAT, started by a PWA, is open to any issue concerning protease inhibitors. To learn more, visit www.pozlink.com. To subscribe, send an e-mail to requests@pozlink.com with the word help in the subject line or body of the message.




[Go to top]

Facebook Twitter Google+ MySpace YouTube Tumblr Flickr Instagram
Quick Links
Current Issue

HIV Testing
Safer Sex
Find a Date
Newly Diagnosed
HIV 101
Disclosing Your Status
Starting Treatment
Help Paying for Meds
Search for the Cure
POZ Stories
POZ Opinion
POZ Exclusives
Read the Blogs
Visit the Forums
Job Listings
Events Calendar


    guycmh328
    Columbus
    Ohio


    soy_Ric
    Rochester
    New York


    Fred9774
    Brooklyn
    New York


    daino1972
    Columbus
    Ohio
Click here to join POZ Personals!
Ask POZ Pharmacist

Talk to Us
Poll
Are you a regular coffee drinker?

Yes
No

Survey
Pop Watch

more surveys
Contact Us
We welcome your comments!
[ about Smart + Strong | about POZ | POZ advisory board | partner links | advertising policy | advertise/contact us | site map]
© 2014 Smart + Strong. All Rights Reserved. Terms of use and Your privacy.
Smart + Strong® is a registered trademark of CDM Publishing, LLC.