Question:

Dear doctor,
In my country, Uganda, so many people mainly identfy HIV/AIDS with deteroriation of body weight. Therefore to avoid public descrimination and isolation, some AIDS victims secretely acquire and use Antiretroviral drugs without seeking proper professional advice of a physician. They do this to avoid growing thin, hence maintaining a healthy outer look. However, as a result some get overweight and obese.

1. What could be the particular effect of any specific ARVs on the body's metabolism? And could their be an effect of the drugs on the level of cholesterol, LDL and HDL in the blood of the victim and could there be any resultant effects on the cardiac function?

2. Recently I read a love story in which the write was narrating his sexual experience with his new girlfriend. He said, "....I then licked her very wet vagina for some time, ...then I put on my condom and then had penetrative sex".
Question: If someone licked the vagina of an HIV victim, could he get infected?

Answer provided by:

Trevor Hawkins, M. D.
Associate Clinical Professor, Dept. Family Practice, University New Mexico
Medical Director, Southwest CARE Center, Santa Fe, NM

1. ARV therapy inhibits viral growth and thus slows down the body's metabolic rate.This will lead to weight increase but rarely obesity.

Different drugs affect fats differently. Briefly, protease inhibitors tend to increase triglycerides (TG) and LDL cholesterol; an exception is atazanavir, which does not. Non nucleosides (NNRTIs) do not affect LDL, may increase HDL and may increase TG's. Nucleosides are lipid neutral except D4T which increases TG.

This, plus the effect of some drugs to increase insulin resistance and maybe to increase inflammation in blood vessels, appears to lead to a modest but significant increase in the number of heart attacks.This can be avoided with careful choice of drugs in patients with cardiac risk factors.

2. Licking a woman's vagina is a rare but possible way to get infected with HIV if she is infected and not on treatment. It is a very unlikely way however, but just possible.

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