Table of Contents: CATIE TreatmentUpdate - 2000


Canadian AIDS Treatment Information Exchange
Edited by: Sean Hosein

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TreatmentUpdate 109: August - Vol. 12, No. 5

 Side Effects

 Effets secondaires

HoseinSR
The precise cause or causes of the body shape changes and abnormal lipid and hormone levels observed in HIV lipodystrophy syndrome are not clear. It may be that several syndromes are in play, such as one that causes people to gain fat, another to lose fat and still another that leads to elevated levels of sugar and insulin in the blood. Although some changes in body shape occur in small numbers of people not taking anti-HIV drugs, most reports about body shape changes are about people who do use such drugs.

 Protease inhibitors and loss of fat

 Inhibiteurs de la protéase et perte de graisse

HoseinSR
Researchers in France conducted laboratory experiments on fat cells with the protease inhibitor indinavir (Crixivan). According to their results, indinavir reduced the formation of fat cells and the sensitivity of fat cells to the hormone insulin.

 Some notes on energy

 Quelques mots au sujet de l'énergie

HoseinSR
Inside nearly all of the body's cells are tiny power plants called mitochondria (Mt). To provide energy to cells, Mt "burn" fat and sugar. This process requires the help of other substances such as B-complex vitamins. When Mt have been damaged by drugs or when they don't have enough B-vitamins, they produce less-than-normal amounts of energy.

 Nukes and fat cell damage

 Analogues nucléosidiques et endommagement des cellules adipeuses

HoseinSR
Doctors in Frankfurt, Germany, took fat samples from the buttocks of 24 HIV-positive subjects for analysis. Fat samples were also removed from eight HIV-negative subjects for purposes of comparison. The average age of subjects did not differ between the two groups.

 Helping to repair damaged nerves

 Réparation des dommages aux nerfs

HoseinSR
Certain nukes, particularly ddC, ddI and d4T, can damage Mt inside nerve cells. In fact, according to doctors in London, England, between 11 and 55% of people using these drugs can develop a form of nerve damage called peripheral neuropathy (PN). There is currently no cure for PN, the symptoms of which may include numbness, tingling or shooting pains in the hands, legs and feet.

 Lactic acidosis

 Acidose lactique

HoseinSR
Another potential complication of anti-HIV therapy, particularly with the use of nukes, is the development of high levels of lactic acid in the blood, a condition called lactic acidosis. Readers should note that lactic acidosis is an unusual occurrence. Indeed, in a recent French study of 800 subjects taking anti-HIV drugs, researchers found that only 1.5% developed lactic acidosis.

 Growth hormone helps get rid of fat

 Hormone de croissance et élimination de la graisse

HoseinSR
In non-HIV-positive people with increased fat deposits on their abdomen, the average production of growth hormone (GH) is less than that seen in people without excess abdominal fat. Small studies have found that giving GH to HIV-negative men has reduced abdominal fat. Doctors in San Francisco thought that giving low-dose GH to HIV-positive subjects with lipodystrophy might help them to lose excess fat.

 Bone problems and anti-HIV therapy

 Maladies des os et thérapie anti-VIH

HoseinSR
A growing number of reports have been made about PHAs who have developed thin and weakened bones, a condition that places them at an increased risk for fractures. In other cases, some people have developed severe joint damage that required hip replacement surgery. It is not yet certain if these complications are due to the impact of HAART, long-term HIV infection or some weird interaction between the two. If osteoporosis (decreased bone mass) proves to be caused by HAART, researchers will have to find out which components of anti-HIV drug regimens - nukes, non-nukes or protease inhibitors - are contributing to the thinning of bones in people with HIV.

 Indinavir and insulin

 Indinavir et insuline

HoseinSR
One of the challenges facing researchers trying to understand HIV lipodystrophy syndrome is separating the effects caused by drugs from those caused by HIV infection. Researchers in San Francisco recruited 10 healthy HIV-negative male subjects whose ages ranged between 30 and 65 years. All subjects received indinavir at a dose of 800 mg three times daily for four weeks. Subjects submitted to a variety of tests before and after they took indinavir.

 Metformin for insulin and heart problems?

 Metformine contre les problèmes d'insuline et de coeur?

HoseinSR
Given the results from the experiments on indinavir reported above, it's not surprising that people taking HAART regimens develop high levels of insulin and sugar in their blood. In addition to high levels of fatty substances in their blood, some PHAs also have elevated levels of a protein called tPA that helps blood to clot. All of these factors increase the risk of developing cardiovascular disease.

 Niacin for cholesterol and weight problems?

 Niacine contre les problèmes de cholestérol et de poids?

HoseinSR
Some doctors in San Francisco think that high levels of "bad" cholesterol (LDL or low density lipoprotein) are associated with the fat accumulation seen in HIV lipodystrophy syndrome. Having high levels of "good" cholesterol (HDL or high density lipoprotein) is not linked to fat accumulation in non-HIV-infected people. The researchers speculate that if they could raise HDL levels in PHAs, they might be able to decrease the amount of fat accumulated by people with lipodystrophy.

Table Of Contents

TreatmentUpdate 113: December - Vol. 12, No. 9
Protease inhibitors and pregnancy — reports from the U.S.; Effect of combination therapy on pregnancy — results from Europe; Two German studies find NAC supplements helpful; How nutrient deficiencies occur; Interferon and ribavirin for hepatitis B; Maintenance therapy for TB works

TreatmentUpdate 112: November - Vol. 12, No. 8
Lopinavir - Results after one year; The benefit of HAART in older people; Large study finds hepatitis C virus infection linked to reduced benefit from anti-HIV drugs; Safety and effectiveness of interferon and ribavirin in HIV+ people co-infected with hepatitis C virus; Vitamin A and abnormal cells on the cervix; FDA issues warning about d4T and ddI during pregnancy; Severe nevirapine rash found more likely in women than men

TreatmentUpdate 111: October - Vol. 12, No. 7
Bone marrow stimulant may boost immunity; MAC prevention takes a holiday; Treating parts of the lipodystrophy syndrome -- blood sugar problems; Metformin for blood sugar problems; Metformin - caution and concerns; Calcium supplements help metformin users absorb vitamin B12; Can antioxidants help reduce side effects from ribavirin?; High levels of testosterone develop in some women with body shape changes; A combination of testosterone and exercise for men

TreatmentUpdate 110: September - Vol. 12, No. 6
Different effects of nukes in men and women; Long-term use of hydroxyurea; Indinavir - 3 years and still going strong; Lymphoma in the age of HAART; Anti-viral therapy for lymphoma; Hydroxyurea as anti-viral therapy for brain lymphomas; Will cidofovir be useful against cervical lesions?; Bone Problems may occur with hepatitis treatment

TreatmentUpdate 109: August - Vol. 12, No. 5
Side Effects; Protease inhibitors and loss of fat; Some notes on energy; Nukes and fat cell damage; Helping to repair damaged nerves; Lactic acidosis; Growth hormone helps get rid of fat; Bone problems and anti-HIV therapy; Metformin for insulin and heart problems?; Niacin for cholesterol and weight problems?

TreatmentUpdate 108: June - Vol. 12, No. 4
Does switching from protease inhibitors to nevirapine restore body shape?; GM-CSF raises CD4+ cell counts; Effect of HIV on the menstrual cycle; Large study looks for protease inhibitor side effects; Protease inhibitors, high triglycerides, hormones and bone damage; Help for protease inhibitor-associated diarrhea; HAART may affect thyroid hormone levels; Indinavir and insulin

TreatmentUpdate 107: May - Vol. 12, No. 3
Testosterone and depression in men; Interferon and ribavirin for hepatitis C; CD8+ cell infusions; CD8+ cells - from suppressors to saviours; AMD-3100 - Chemokine blocker under study; Antibiotic holidays may be OK for some

TreatmentUpdate 106: March - Vol. 12, No. 2
Early versus delayed therapy - results from Switzerland; Questions about the early and aggressive use of therapy; Rescue Therapy; Infections after HAART- who is at risk?; The risk of cervical dysplasia;

TreatmentUpdate 105: February - Vol. 12, No. 1
Trizivir - three drugs in one pill; TXU-PAP - early results; Hitting hard, hitting early - one year later; Efavirenz versus indinavir: Who really wins?; Cream reduces reappearance of cervical lesions; Study finds that HAART is OK for some people co-infected with hepatitis B and C virus

TreatmentUpdate 104: January - Vol. 11, No. 10
Immunotoxins to the rescue; Cytokines can help fight HIV; HAART as an immune booster; A placebo-controlled study of Chinese herbs; Curcumin - some issues to consider; Curcumin and the immune system; Mistletoe extract for HIV/AIDS?;

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