By Caitlin McHugh and Courtney McQueen
Published: Aug 2, 2010 1:44 pm
Several studies presented at the 2010 International AIDS Conference examined lipodystrophy and the effects of antiretroviral medications on cholesterol levels.
Lipodystrophy is a common side effect associated with HIV treatments. It causes changes in fat distribution that can lead to changes in body shape, increased levels of lipids (cholesterol and fatty acids) in the blood, and greater risk of heart problems.
Symptoms of lipodystrophy include loss of fat in the legs, face, arms, and buttocks; and an increase of fat in the stomach, upper back or neck, and breasts.
One of the studies looked at factors affecting lipodystrophy and poor body image. Another study showed that ultrasonic liposuction is an effective treatment for “buffalo hump,” excess fat on the back of the neck.
Several other studies focused on antiretroviral drugs, particularly protease inhibitors, and their association with high cholesterol.
Switching from Epzicom (abacavir/lamivudine) to Truvada (emtricitabine/tenofovir) was found to improve cholesterol levels.
An evaluation of protease inhibitors showed that although they do not always cause increased lipid levels, combining protease inhibitors is more likely to cause increased lipids. Another study found that protease inhibitors caused high cholesterol and high triglycerides in children and adolescents.
Also, once daily administration of Prezista (darunavir) plus Norvir (ritonavir), with a lower total dose, improved lipid levels compared to twice daily administration.
Factors Associated With Lipodystrophy And Poor Body Image
This study followed 337 people with HIV for three months to examine any links between lipodystrophy, poor body image, and other conditions such as depression and anxiety.
Poor body image increased as participants experienced more lipodystrophy symptoms, including increased stomach fat, thin arms or legs, fat on the back of the neck, and visible leg veins.
Lipodystrophy symptoms were more frequent in patients who were white or Hispanic, had AIDS, or whose antiretroviral medications were all in the same drug class. Participants with undetectable viral loads showed fewer lipodystrophy symptoms.
Most participants with lipodystrophy also reported other conditions, including depression (62 percent), fatigue (62 percent), nerve damage (58 percent), anxiety (50 percent), diarrhea (43 percent), and nausea (38 percent).
The researchers concluded that even with improved antiretroviral regimens, lipodystrophy and poor body image are still a problem. They also suggested other conditions, such as nausea and depression, may affect development of poor body image.
Ultrasonic Liposuction May Successfully Treat “Buffalo Hump”
In this study, Spanish surgeons removed excess fat accumulation on the back of the neck (“buffalo hump”) of 26 HIV-positive patients, using ultrasonic liposuction. Patients were evaluated 24 and 48 weeks after the surgery.
Ultrasonic liposuction is a form of liposuction, or fat removal, which uses sound waves to liquefy fat.
The surgeons were able to use ultrasonic liposuction to remove an average of 47 fluid ounces of liquefied fat from the patients.
The most common side effects of the liposuction were bruising and swelling. None of the patients had serious side effects from the surgery after 48 weeks; one patient had to undergo additional surgery after 42 weeks because fat had reappeared.
Most of the patients (92 percent) reported that they were “satisfied” or “very satisfied” with the results of the liposuction.
Researchers concluded that ultrasonic liposuction is an effective and safe treatment for the removal of fat accumulation on the back of the neck.
Rate And Predictors Of Metabolic Syndrome Development After Starting Antiretroviral Treatment
In this study, researchers examined the rate of and risk factors for metabolic syndrome development in people with HIV who had been on antiretroviral therapy for less than four years.
Metabolic syndrome is characterized by insulin resistance (pre-diabetes), high blood pressure, and high blood lipid levels.
Metabolic syndrome occurred in 18 percent of the study participants, which is similar to the rate found in previous studies of people with HIV taking antiretrovirals.
The results revealed that older age, hepatitis C infection, high cholesterol, and longer exposure to protease inhibitors increased the risk of developing metabolic syndrome.
Length of HIV infection, CD4 (white blood cell) count, and viral load (amount of virus in the blood) were not associated with risk of developing metabolic syndrome.
Switching From Epzicom To Truvada Reduces Cholesterol
In a 12-week study of 85 adults with HIV, participants were randomly assigned to either continue on Epzicom and Kaletra (lopinavir/ritonavir) or switch to Truvada plus Kaletra. Results showed that switching to Truvada improved cholesterol levels slightly while maintaining viral control.
Previous studies have shown that medications containing abacavir, such as Epzicom, can cause high cholesterol.
Researchers predicted that switching from an antiretroviral therapy regime with Epzicom, a combination of abacavir and lamivudine, to one with Truvada, which does not contain abacavir, would improve cholesterol levels in participants.
As predicted, the results revealed that switching from Epzicom and Kaletra to Truvada and Kaletra maintained HIV viral control, improved cholesterol levels, and decreased the participants’ risk of heart disease.
Combining Protease Inhibitors May Increase Cholesterol And Triglyceride Levels
Another study evaluated the effect of protease inhibitors on levels of lipids – cholesterol and triglycerides.
In the past, protease inhibitors have been associated with increased cholesterol and triglyceride levels. This study examined patients on protease inhibitor-only regimens to allow researchers to see the drugs’ effects on blood lipid levels without other types of antiretrovirals complicating the results.
Researchers analyzed lipid levels of a total of 78 adults with HIV who were taking protease inhibitors only. Although cholesterol and triglyceride levels both increased slightly over 48 weeks, the researchers did not consider the changes large enough to be significant.
However, the researchers did observe that combining protease inhibitors, such as Reyataz (atazanavir) plus Kaletra, or Lexiva (fosamprenavir) plus Invirase (saquinavir mesylate) and Norvir, raised “bad” cholesterol levels significantly more than just a single protease inhibitor.
They concluded that protease inhibitors do not always raise lipid levels, but combining them may increase the risk of developing high cholesterol.
Protease Inhibitors May Increase Cholesterol And Triglycerides In Children And Adolescents
An HIV clinic in Romania evaluated cholesterol and triglyceride levels in 130 children and adolescents between the ages of 9 and 18 whose antiretroviral regimens included protease inhibitors.
After 12 months, the researchers found that a large number of the children had high cholesterol (35 percent) and/or high triglyceride levels (39 percent). In addition, 8 percent had high blood sugar levels.
These abnormalities were more common in patients who had previously been treated with protease inhibitors than in patients taking protease inhibitors for the first time.
Although most of the cases were mild, three of the children did experience severe metabolic abnormalities that forced them to discontinue antiretroviral therapy.
Lower Cholesterol And Triglyceride Levels Are Associated With Once Daily Prezista/Norvir, Compared to Twice Daily Therapy
A Phase 3b study compared the effectiveness and impact on lipid levels – cholesterol and triglycerides – of once daily versus twice daily dosages of the protease inhibitor Prezista plus Norvir. The total dosage per day for once daily administration was lower (800 milligrams) than for twice daily administration (1,200 milligrams).
The study took place over 48 weeks and examined treatment-experienced HIV-positive adults.
High cholesterol and triglyceride levels occurred significantly less in the group of participants taking the once daily dosage of Prezista/Norvir than in the group taking the twice daily dosage.
The researchers also showed that the once daily dosage was as effective as the twice daily dose and was well tolerated.
For more information, please see the AIDS 2010 conference website.
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