The Washington Blade - March 9, 2001
Lisa Keen

The study confirmed earlier reports that suggested the incidence of this problem, lipodystrophy, increased the longer patients were on the antiviral medications. But while early reports also suggested the lipodystrophy was mostly associated with the protease inhibitors, this study implicated nucleoside analogs, too, and found some suggestion that the longer a patient is on the protease inhibitor indinavir, the more likely the patient would experience "central obesity" - fat accumulation in the trunk of the body.

Abnormalities in metabolizing fat have been associated with the use of antivirals since 1998 and manifest themselves in at least two major ways - the pronounced loss of fat (lipoatrophy) and the pronounced increase in fat (central fat accumulation). The lipoatrophy left patients looking emaciated even when they were feeling well, and the fat accumulation left them looking overweight or with so-called "buffalo humps" on their shoulders. There were other metabolic complications too, some of them life-threatening. But the Spanish study zeroed in on the fat loss/accumulation phenomenon.

The team studied 494 patients with HIV from the moment they began on the triple-drug therapy to monitor for both fat accumulation and loss. Within 18 months, 85 patients (17 percent) had developed lipodystrophy - 45 percent had both forms, 34 percent had fat loss only, and 21 percent had the accumulation in the trunk, and usually in the belly. By 24 months, 23 percent of the patients were experiencing some form of lipodystrophy.

"Each additional six months on HAART [triple-drug therapy] was associated with a 45 percent increased risk of any lipodystrophy .... and there was a significantly increased risk of lipodystrophy," wrote the authors, "with increasing exposure to" the nucleoside analogs 3TC, d4T, ddI, and the protease inhibitor indinavir. Additional analyses found the increased risk even higher with each six months on therapy but less association with the specific medications.

Bottom line? "Risk factors associated with the development of lipodystrophy .... in patients with HIV-1 who were receiving [triple drug therapy that included a protease inhibitor] are multifactoral and overlapping, and cannot be exclusively ascribed to the duration of exposure to a particular antiviral agent."

In brief ...

FILTER THE COFFEE: In a study totally unrelated to HIV disease but involving problems with fat and cholesterol, researchers at Johns Hopkins University and other centers recently reported that drinking six cups of coffee is "significantly associated with an increase in total cholesterol" but the problem is not the caffeine. The problem, said the researchers in the Feb. 15 issue of the American Journal of Epidemiology, is "due to coffee oils, such as cafestol and kahweol." The use of filters (rather than boiling coffee) reduced the cholesterol producing effect of these oils.

EVERY 50 DAYS: Also in the Feb. 15 issue of the American Journal of Epidemiology, researchers from France report that, after the first four months that a patient with HIV is on antiviral therapy that includes a protease inhibitor, he or she experiences a significant reduction in risk of acquiring an opportunistic infection with every 50 CD4-cell increase his blood achieves. The researchers said their findings give further support for the cessation of certain preventive medications.

AZT BEFORE D4T: A report in the Jan. 1 Journal of Acquired Immune Deficiency Syndromes suggests people with HIV have greater success reducing their viral loads by taking AZT first, rather than d4T.

FIGHTING FATIGUE: A report from researchers in New York, published in the Feb. 12 issue of the Archives of Internal Medicine, indicates that the use of the prescription drug Ritalin, used most often to treat attention deficit disorder in children, helps significantly in remedying fatigue in people with HIV.

FLU ALERT: The most recent flu report from the U.S. Centers for Disease Control and Prevention indicates that influenza is "widespread" in New Jersey, "regional" in New York and Maryland (meaning outbreaks are occurring in areas containing less than 50 percent of the state's population), and "sporadic" in Washington, D.C., and Virginia.

LIVER DISEASE: Another study indicates the increasing incidence of liver disease in people with HIV. Several reports at last month's Retrovirus Conference indicated an increasing number of people with HIV succumbing to liver disease. Reuters reports that the Feb. 1 issue of Clinical Infectious Diseases journal includes an article from the New England Medical Center in Boston indicating that 50 percent of patients on triple-drug therapy are now succumbing to end-stage liver disease, compared to less than 12 percent who did so prior to the availability of protease inhibitors.

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