 |
|
|
| |
Bulletted Highlights From Lipodystrophy and Adverse Drug Reactions in HIV Workshop
Lipodystrophy Workshop in Athens - Thursday October 25
Written by Jules Levin
|
| |
| |
The Lipodystrophy and Adverse Drug Reactions in HIV Workshop just ended.
Further reports will be forthcoming but here are some bulletted highlights:
- Body changes, metabolic abnormalities (cholesterol, triglycerides, sugar),
and bone problems appear to be multifactactorial in causation. In other words
there are very likely many abnormalities and causes going on at the same time
in a patient's body that leading to these manifested abnormalities.
- There was a poster presentation reporting improved facial fat loss using
rosiglitazone, an anti-diabetic drug, but the reports of improvement were
patient and
doctor reports. More objective studies using objective measures evaluating
changes in fat in the face, limbs, and belly are needed. Some of the
objective measures in the study did not jive with the patient & doctor
reports. But there is a feeling among some of the researchers I spoke with
here that rosiglitazone may be helpful for reversing fat loss.
- Data was reported here associating nevirapine hepatic toxicity with
nevirapine blood levels. It was suggested this could be true with other
drugs. It was also suggested that liver impairment, which could come from
hepatitis C, of a certain degree may increase drug blood levels. These
questions need to be studied better.
- Kathy Mulligan reported today on the use human growth hormone (HGH) using 3
mg/day. She reported improved lipid profiles but worsening glucose under both
fasting and hyperinsulinemic conditions. She said these results suggest that
treatment with a pharmacuetical dose of GH is associated with hepatic, as
well as peripheral insulin resistance that might lead to elevated sugar. She
suggested testing for glucose tolerance before using HGH and diabetics should
not use HGH. Further testing of HGH will be done with lower & less frequent
dosing to see if this improves safety while retaining effectiveness.
- It was discussed how insulin resistance can occur in muscle, liver, and the
periphery.
- Indinavir caused glucose increases in vitro, in animals, and in single
doses in HIV negative individuals. The increase occurs quickly. Other PIs
also appear to cause this but studies on them were just briefly mentioned.
However, Mike Dube and Jacqueline Capeau reported study results showing
insulin resistance did not appear to occur until 48 weeks on amprenavir and
fat loss in the periphery did not occur at all at 48 weeks. However, the
study was done mostly in hispanics and longer evaluation than 48 weeks would
yield better information.
- Nephrotoxicity from indinavir may be more of a concern in females.
- Heart disease appears to loom as a potential problem in the future and risk
factors such as smoking, diet, exercise, cholesterol were reported to be more
of a concern than HAART itself.
- Cecilia Shikuma reported mitochondrial toxicity was found more often in
patients with lipodystrophy suggesting a more direct association with NRTIs
and lipodystrophy.
- However, Simon Mallal believes that it is a combination of NRTIs and PIS
that lead to body changes in the short run (1 year). That double nukes alone
will not lead to short term body changes. And he believes double PIs alone
are less offensive. It is the class combinations of a PI and nukes that be
believes yield the worse fat loss.
|
|
| |
|
|
|
|
|
