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"It
remains controversial as to how to treat high cholesterol in HAART patients.
"
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Lipodystrophy
Swiss investigators recently
completed a systematic
study of background data on adverse effects to antiretroviral treatment.
(1) Data from 1,160 outpatients in the Swiss HIV Cohort Study indicated
that 47% of the patients had clinical adverse effects from highly active
antiretroviral therapy (HAART) of which 9% were graded as serious or severe.
HIV-1 viral load, age, and antiretroviral therapy are linked
with the development of lipodystrophy. (2) Research reported on from
Boston notes the effect of HAART on fat, lean, and bone mass in HIV-positive
people. (3) Using dual-energy X-ray absorptiometry (DEXA), researchers
compared total and regional body composition in 265 HIV-positive individuals.
Study
participants on HAART displayed increased trunk fat with lower leg fat,
which corresponded to a greater percentage of total fat mass located in
the trunk than those individuals not on HAART. Men on HAART displayed lower
total and regional bone mineral content and greater lean body mass with
longer duration of HAART. The largest differences in regional fat were
associated with protease inhibitors. Preliminary
studies have shown that HIV-positive children on HAART show fat distribution
changes even in the absence of lipodystrophy. (4)
Marshall J. Glesby, MD,
PhD, reviews information on metabolic complications of HAART including
coronary artery disease risks at the
HIVInSite web site. Free
fatty acids may contribute to worsening insulin resistance. Treatment
options (5) and general
guidelines on the management of drug-induced dyslipidaemia are available.
(6) It remains controversial
as to how to treat high cholesterol in HAART patients.
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Sources
1. Fellay J, Boubaker
K, Ledergerber B, Bernasconi E, et al. Prevalence of Adverse Events Associated
with Potent Antiretroviral Treatment: Swiss HIV Cohort Study. Lancet 2001;358(9290):1322-1327.
2. Boufassa F, Dulioust
A, Lascaux AS, Meyer L, et al. Lipodystrophy in 685 HIV-1-treated patients:
influence of antiretroviral treatment and immunovirological response. HIV
Clin Trials 2001;2(4):339-45.
3. McDermott AY, Shevitz
A, Knox T, Roubenoff R, Kehayias J, Gorbach S. Effect of highly active
antiretroviral therapy on fat, lean, and bone mass in HIV-seropositive
men and women. Am J Clin Nutr 2001;74(5):679-86.
4. Brambilla P, Bricalli
D, Sala N, Renzetti F, et al. Highly active antiretroviral-treated HIV-infected
children show fat distribution changes even in absence of lipodystrophy.
AIDS 2001;15(18):2415-2422.
5. Behrens GM, Stoll M,
Schmidt RE. Lipodystrophy syndrome in HIV infection: what is it, what causes
it and how can it be managed? Drug Saf 2000;23(1):57-76.
6. Mantel-Teeuwisse AK,
Kloosterman JM, Maitland-van der Zee AH, Klungel OH, et al. Drug-Induced
lipid changes: a review of the unintended effects of some commonly used
drugs on serum lipid levels. Drug Saf 2001;24(6):443-56.
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