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HIV Lipoatrophy 2007
 

HIV Lipoatrophy 2007

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Easy to understand, comprehensive overview of fat loss in HIV disease. Answers 3 key questions: What?...Why?....How?

Easy to understand, comprehensive overview of fat loss in HIV disease. Answers 3 key questions: What?...Why?....How?

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  • This CEU-accredited slide set, “The What, the Why, and the How of Lipoatrophy in HIV” was produced by Visionary Health Concepts and can be also viewed and downloaded on our website, www.freehivinfo.com. Visionary Health Concepts developed this slide set to be the first in a series on special topics in HIV. Check on www.freehivinfo.com for this and upcoming downloadable slide sets and while you are there, please be sure to tell them what other special topics you’d like them to cover in the future. This presentation is focused solely on lipoatrophy—fat loss-—in HIV. Please review the CEU accreditation information on the following slides prior to accessing the presentation which starts on slide #10.

HIV Lipoatrophy 2007 HIV Lipoatrophy 2007 Presentation Transcript

  • © Visionary Health Concepts, New York 2007 Released October 5, 2007
  • About these slides
    • Users are encouraged to use these slides in their own presentations, but we ask that content and attribution not be changed. Users are asked to honor this intent.
    • These slides may not be published or posted online without permission from Visionary Health Concepts.
    • Disclaimer The materials published on the Visionary Health Concepts website reflect the views of the authors of the VHC material, not those of Visionary Health Concepts, Inc., the CME providers, or the companies providing educational grants. The materials may discuss uses and dosages for therapeutic products that have not been approved by the United States Food and Drug Administration. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or using any therapies described in these materials.
  • The What, the Why, and the How of Lipoatrophy in HIV CEU Information Accreditation Statement(s): ANCC Medical Education Collaborative (MEC) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. RNs, LPNs, LVNs and NPs can receive up to .7 contact hours for participation in this program. This program is cosponsored with Medical Education Collaborative, Inc. (MEC) and Visionary Health Concepts. Provider approved by the California Board of Registered Nursing, Provider Number CEP 12990, for .8 contact hour(s). Joint Sponsor This activity is joint sponsored by Visionary Health Concepts and Medical Education Collaborative (MEC). MEC is a non-profit organization that has been certifying quality educational activities since 1988.   Commercial Support This activity was made possible by an educational grant from Abbott Laboratories.
    • Learning Objectives Upon completion of this educational activity, participants should be able to:      
      • Recognize the physical symptoms of HIV-associated lipoatrophy
      • Assist patients in understanding the way lipoatrophy is diagnosed and treated
      • Discuss recent studies related to ART and lipoatrophy
    • Target Audience
      • This program is intended for all healthcare providers, including nurses, treating HIV-positive patients, especially those who are seeking current and comprehensive information on lipoatrophy.
    The What, the Why, and the How of Lipoatrophy in HIV CEU Information
    • Purpose Statement
      • The purpose of this program is to increase and improve patient/provider communication on the topic of lipoatrophy by providing both a simple, yet comprehensive, overview of the topic and an update of recent data related to the topic.
    • Release & Expiration Dates
    • Release date: October 5, 2007; Expiration date: October 5, 2008
    •   Instructions for Credit
    • There are no fees for participating in or receiving credit for this educational activity. This activity was developed to be completed within the time designated on the title page; providers should claim only those credits that reflect the time actually spent in the activity. For questions regarding the accreditation of this activity, please contact Medical Education Collaborative at 303-420-3252.
      • Follow these steps to earn CEU:
      • Read the target audience, learning objectives , and faculty disclosures.
      • Study the educational content online or printed out.
      • Online, choose the best answer to each test question.
      • You many also print out and return the completed test to toll-free fax 800-407-2505.
      • To receive a certificate, participants must score at least a 70% on the post test and
      • submit it along with the credit application and evaluation form to the address/fax
      • number indicated. Statements of credit will be mailed within 6-8 weeks following the program.
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    • VHConcepts requires version 4.x browsers or higher from Microsoft or Netscape. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash , Apple Quicktime , Adobe Acrobat , Microsoft Powerpoint , Windows Media Player , and Real Networks Real One Player .
    The What, the Why, and the How of Lipoatrophy in HIV CEU Information
  • Faculty Disclosures The planning committee and faculty members have the following disclosures:  CEU Chairperson Andrew Carr, MBBS, MD, FRACP, FRCPA St. Vincent's Hospital; Professor of Medicine, University of New South Wales, Sydney, Australia Dr. Andrew Carr has the following relationships to disclose: grants for paid research, speaker’s bureau and advisory boards from Abbott Laboratories. Editor Maggie Sosa, APRN, BC, AACRN, ACHPNNP Nurse Practitioner, Broadway House for Continuing Care, Newark, NJ, USA Maggie Sosa has no relationships to disclose. The What, the Why, and the How of Lipoatrophy in HIV CEU Information
  • Faculty Disclosures continued Writers Lillian Thiemann President, Visionary Health Concepts, Gardiner, NY, USA   Lillian Thiemann has no relationships to disclose.               Deneen Robinson Savant Consultants, Dallas TX, USA Deneen Robinson has the following relationships to disclose: stock ownership: Abbott Laboratories; advisory committee: Bristol-Myers Squibb; speaker’s bureau: Gilead Sciences. Accredited Provider The employees of Medical Education Collaborative, the accredited provider for this activity, have no significant relationships to disclose.   The What, the Why, and the How of Lipoatrophy in HIV CEU Information
  • In The What, The Why, and The How of Lipoatrophy in HIV slide set, we’ll:
    • Describe what lipoatrophy is, and what it’s not
    • Discuss current studies about lipoatrophy in HIV
    • Provide information on surgical and non-surgical treatment of lipoatrophy
  • We’ll also:
    • Explore the myths (and realities) of fat loss
    • Provide tips for better communication with patients
    • Point out the differences between lipoatrophy and AIDS wasting
    • Review types of body fat changes (lipodystrophy)
  • Antiretroviral therapy extends life Percentage of persons surviving through June 2005, by years after acquired immunodeficiency syndrome (AIDS) diagnosis cohorts during 1981-2003 and by year of diagnosis--United States [Centers for Disease Control and Prevention 2005]
  • WWW.FREEHIV.COM DRUG CHART Currently-approved HIV medications Easy-to-print version available at www.freehivinfo.com NRTI, NtRTI - Nucleoside and or Nucleotide Reverse Transcriptase Inhibitors (nukes) Brand name (generic name, abbreviation) Picture Year approved Retrovir ® (zidovudine, AZT) 1987 Videx ® (didanosine; ddI): buffered versions 1991 Zerit ® (stavudine; d4T) 1994 Epivir ® (lamivudine; 3TC) 1995 Combivir ® (Retrovir + Epivir, CBV) 1997 Ziagen ® (abacavir, ABC) 1998 Trizivir ® (Retrovir + Epivir + Ziagen) 2000 Videx ® EC (didanosine; ddI): delayed-release capsules 2000 Viread ® (tenofovir DF, TDF) 2001 Emtriva ® (emtricitabine, FTC) 2003 NNRTI - Nonnucleoside Reverse Transcriptase Inhibitors (non-nukes) Brand name (generic name, abbreviation) Picture Year approved Viramune ® (nevirapine, NVP) 1996 Rescriptor ® (delavirdine, DLV) 1997 Sustiva ® (efavirenz, EFV) 1998 Atripla™ (Sustiva* + Viread + Emtriva), * Viread and Emtirvia are non-nucleoside reverse transcriptase inhibitors (NRTIs). 2006 Crixivan ® (indinavir, IDV) 1996 Norvir ® (ritonavir, RTV) 1996 Viracept ® (nelfinavir, NFV) 1997 Kaletra ® (lopinavir + ritonavir, LPV/RTV) 2000 Lexiva ® (fosamprenavir, fos-APV) 2003 Reyataz ® (atazanavir, ATV) 2003 Aptivus ® (tipranavir, TPV) 2005 Prezista™ (darunavir) 2006 Epzicom ® (Ziagen + Epivir) 2004 Truvada ® (Viread + Emtriva) 2004 Atripla™ (Sustiva* + Viread + Emtriva) * Sustiva is a non-nucleoside reverse transcriptase inhibitor (NNRTI) 2006 PI - Protease Inhibitors Brand name (generic name, abbreviation) Picture Year approved Invirase ® (saquinavir, SQV) 1995 Entry Inhibitors (including Fusion Inhibitors and CCR5 Antagonists) Brand name (generic name, abbreviation) Picture Year approved Fuzeon ® (enfuvirtide, T-20) 2003 Selzentry ® (maraviroc) 2007
  • Lipo dystrophy ( lipo- diss -troh-fee )
    • Lipo means fat, and the word dystrophy means abnormal looking
    • A general “umbrella” term that is used to describe various changes that occur in the body in how it uses and distributes FAT
    • The conditions that fall under the lipodystrophy umbrella can be very different in cause and effect
  • Lipodystrophy umbrella
  • Lipo atrophy ( lip-oh- aah -troh-fee )
    • Lipo means fat and atrophy means shrinkage lipoatrophy = “fat loss”
    • Is often seen in people living with HIV who take anti-HIV drugs
    • Also can occur in those with HIV who have never taken anti-HIV drugs, and in other diseases such as diabetes or in rare genetic diseases
  • AIDS wasting is not lipoatrophy Fat loss Weight loss & diarrhea CD4 Count HIV under control? Associated with risk of death? Affects looks? AIDS Wasting yes yes Less than 50 No yes yes Lipoatrophy (fat loss) yes no Over 200 yes no yes
  • Lipoatrophy occurs in fat under the skin
      • Face
      • Arms
      • Legs
      • Buttocks
  • Lipoatrophy occurs gradually
    • At first:
    • Legs, arms and face appear thinner
    • People may like that their cheekbones are starting to stand out a little and that their body looks a little more “cut”
    • Then, as fat loss continues:
    • Skin loosens, becomes thinner
    • Bones, veins, tendons and muscles become much easier to see
  • Examples of lipoatrophy (men)
  • Examples of lipoatrophy (women)
  • FRAM Study Group [FRAM Study Group. J Acquir Immune Defic Syndr. 2005;40:121-131.] [FRAM Study Group. J Acquir Immune Defic Syndr . 2006;42:562-571.] Peripheral Lipoatrophy (%)
      • Belly fat gain
    Belly fat loss No Yes Belly fat loss Men (n=425) Women (n=183) Peripheral Lipoatrophy (%)
      • Belly fat gain
    100 80 60 40 20 0 100 80 60 40 20 0
  • How many people have lipo?
    • Reports vary from as little as 8% to 84%
      • Largest studies suggest 40% to 65%
      • The estimates are affected by how long people have been on HIV treatment and what type of HIV medication
    • Reported less often in women—10% to 35%, and may be low due to underreporting.
    [Bernasconi E et al. JAIDS 2002;31:50.] [Young J et al. Antiviral Therapy 2005;10:73.] [Miller J et al. HIV Med 2003;4:293.] [Lichtenstein KA et al. 13 th CROI 2006; Denver. Abstract #769.] [Chen D et al. J Clin Enocrinol Metabol 2002;87:4845.]
  • Cause of lipoatrophy
    • Anti-HIV medications are associated with fat loss
    • Some anti-HIV medications cause more fat loss than others
    [Lichtenstein KA. J Acquir Immune Defic Syndr. 2005; 39:395-400.] [Jacobson DL, et al. Clinical Infectious Diseases 40(12):1837-1845. June 15, 2005.] [Parker RA, etal. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV , 2005, Dublin, Ireland. Abs 4.. Antiviral Therapy 2005; 10 : L5]
  • Families of HIV drugs: Nucleoside reverse transcriptase inhibitors (NRTIs) Brand name Generic name Image Atripla™ (Sustiva* + Viread + Emtriva) efavirienz + tenofovir + emtricitabine Combivir ® (Retrovir + Epivir) zidovudine + lamivudine Emtriva ® emtricitabine, FTC Epivir ® lamivudine; 3TC Retrovir ® zidovudine, AZT Trizivir ® (Retrovir, Epivir + Ziagen) zidovudine + lamivudine + abacavir Brand name Generic name Image Truvada ® (Viread + Emtriva tenofovir + emtricitabine Videx ® didanosine; ddI Videx ® EC didanosine; ddI Viread ® tenofovir DF, TDF Zerit ® stavudine; d4T Ziagen ® abacavir, ABC
  • What are mitochondria?
    • Mitochondria are the cell’s ‘energy factories’ where sugar and fat are burned to turn it into energy
    • If mitochondria are damaged, fat cells start to shrink and then die
  • Switching anti-HIV drugs Change from baseline (kg) Week Switching NRTIs d4T/AZT did help reverse the fat loss. However, there was no return to “normal”. [Carr et al, AIDS 2001] [Martin et al, AIDS 2004] [McComsey et al, Clin Infect Dis 2004] [Milinkovic et al, CROI 2005] [Carr et al, JAMA 2002] [ Moyle et al, CROI 2005] [Murphy et al, CROI 2005]
  • Families of HIV drugs: Non nucleoside reverse transcriptase inhibitors (NRTIS) Brand name Generic name Image Atripla™ (Sustiva* + Viread + Emtriva) efavirienz + tenofovir + emtricitabine Rescriptor ® delavirdine, DLV Sustiva ® efavirenz, EFV Viramune ® nevirapine, NVP
  • ACTG 5142
    • ACTG 5142: A study that compared three anti-HIV drug combos
      • NNRTI + 2 NRTIs [Sustiva (efavirenz) + 2 NRTIs]
      • Protease inhibitor + 2 NRTIs [Kaletra (lopinavir/rt)+ 2 NRTIs]
      • NNRTI + PI [Sustiva + Kaletra (no NRTIs)]
    • Results:
      • Sustiva + NRTIs is two times more likely to cause fat loss (lipoatrophy) than Kaletra + NRTIs
      • Sustiva + Kaletra had lowest rate of fat loss
        • 8% at 96 weeks compared to 36% in Sustiva + NRTIs arm vs 18% in Kaletra + NRTIs arm
      • Patients using Viread (tenofovir, TDF) had less fat loss compared to other NRTIs used—Retrovir (AZT) or Zerit (d4T)
    [Haubrich R, Riddler S, DiRienzo G, et al. 14th CROI, Los Angeles, 2007, Abs 38.] [Riddler SA, Haubrich R, DiRienzo G, et al. XVI International AIDS Conference, Toronto, 2006, Abs THLB0204.]
  • Families of HIV drugs: Protease Inhibitors (PIs) Brand name Generic name Image Aptivus ® tipranavir, TPV Crixivan ® indinavir, IDV Invirase ® saquinavir, SQV Kaletra ® lopinavir + ritonavir, LPV/RTV Lexiva ® fosamprenavir, fos-APV Brand name Generic name Image Norvir ® ritonavir, RTV Prezista™ darunavir, DRV Reyataz ® atazanavir, ATV Viracept ® nelfinavir, NFV
  • Families of HIV drugs: Entry Inhibitors Brand name Generic name Image Fuzeon ® enfuvirtide, ENF Selzentry ® maraviroc, MRV
  • Summary of factors
    • Factors not associated with lipoatrophy:
    • Diabetes
    • Lower nadir CD4+ cell counts
    • White race
    Ass
    • Factors associated with lipoatrophy:
    • Specific NRTIs (Zerit and
    • Videx)
    • Lower baseline CD4,
    • body mass index (BMI),
    • Cholesterol treatment
    [Lichtenstein KA. J Acquir Immune Defic Syndr. 2005; 39:395-400;] [Moyle, G. et al. The Rave Study. ICAAC, 2005]
  • SMART Study
    • People experiencing fat loss ask, “SHOULD I STOP MY PILLS?”
    • The short answer is: “NO!”
    • The long answer includes information about the SMART Study:
      • A huge study (5,472 people), SMART compared continuous anti-HIV treatment against intermittent (“on and off”) treatment to see
      • if side effects could be lessened and the virus still controlled or suppressed
      • The study was stopped because of more AIDS and more deaths in the intermittent group; risk of heart disease was also greater in this group
    [Phillips A, Carr A, Neuhaus J, et al. CROI 2007 Abs 41. ]
  • Take-home messages
    • Daily, continuous anti-HIV treatment is better for the heart AND for controlling HIV than “on and off” anti-HIV treatment
    • Some anti-HIV drugs cause less fat loss than others
    • It’s better to avoid fat loss than to try to get fat back once it’s gone
  • Detecting fat loss
  • Facial lipoatrophy grading Progression of facial fat loss
      • Grade 1 : Obvious only to patient
      • Grade 2 : Others start to notice
      • Grade 3 : Everyone notices
      • Grade 4 : Mirrors become the enemy
    [Grinspoon, Carr. N Engl J Med 2005; 352:48.] [James J et al. Dermatol Surg 2002;11:979–986.]
  • Self-reported fat loss 10 20 30 40 50 60 70 0 10 20 30 40 50 60 70 Upper Back Abdominal Fat Waist Chest Neck Legs Buttocks Arms Face Cheeks 0 Men Women HIV+ HIV- % Reporting Fat Loss % Reporting Fat Loss [FRAM Study Group. J Acquir Immune Defic Syndr. 2005;40:121-131.] [FRAM Study Group. J Acquir Immune Defic Syndr . 2006;42:562-571.]
  • Tools to measure fat loss
      • Different amounts x-ray energy are absorbed by fat, muscle and bone
      • Exposes patient to only 20% of the radiation that a regular chest x-ray uses
      • Very accurate; r ecommended at change of HIV therapy , especially when fat loss is reason for switch
      • Covered by most insurance
    DEXA (Dual-Energy X- ray Absorptiometry) [Levine J et al. J Appl Physiol 2000;88:452.] [Kamel E. et al Obes Res 2000;8:36.] [Mitsiopouools J Appl Physiol 1998;85:115.]
  • Tools to measure fat loss (2)
      • Uses x-rays to look at slices of the body. Expensive, more commonly used to measure fat gain, exposes patient to radiation, 1 per year allowed.
    Lower jaw (mandible) measure - left [Carey D et al. CROI 2007; Los Angeles. Abs #40.] CAT scan
    • Baseline mandible - left
    • Baselines drawn between points of bone
    • Maximum distance to skin line measured
  • Tools to measure fat loss (3) Skin-fold test A metal tool is used to “pinch” body tissue in several places. The measurements are compared to standards. Requires a skilled technician. MRI (Magnetic Resonance Imaging) uses a magnetic field to create an image of the body showing the location and amount of fat; very expensive [Levine J et al. J Appl Physiol 2000;88:452.] [Kamel E. et al Obes Res 2000;8:36.] [Mitsiopouools J Appl Physiol 1998;85:115.]
  • Tools to measure fat loss (4)
    • Waist-to-hip ratio uses a mathematical formula to measure fat:
      • May not hold true for people with HIV who have gained fat around the waist
      • Gender and how much a person is overweight has
      • to be brought into the equation
  • Take-home messages
    • DEXA is the best test to get an all-around look at fat loss:
      • Reliable and fairly easy to get for most people in the US
      • Can measure facial fat loss
      • Also measures bone density
  • So why does fat loss matter?
  • Fat loss and stigma
    • Fat loss may:
    • Be an unintentional signal to others of HIV-positive status
    • Decrease a person’s confidence and social involvement
    • Cause a person to avoid or stop needed anti-HIV medication because of fear of stigma
    [O’Donovan CA, et al.. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005, Dublin, Ireland. Abs 34. Antiviral Therapy 2005; 10 : L24.]
  • HIV-related stigma
    • The general public still fears and judges people living with HIV, and such feelings can:
      • Cause negative feelings toward persons living with HIV/AIDS, their families and friends
      • Make it easy to justify treating those of different gender, sexuality, and race badly
    [Rintamaki L, Davis T, et al. AIDS Patient Care and STDs. 2006, 20(5): 359-368. doi:10.1089/apc.2006.20.359.]
  • Management options
    • Non-surgical options
    • Surgical options
    Two main types of management options have been studied in clinical trials:
  • The goal is to look normal
  • Can’t we just take another pill? [Slam L, et al. 13th CROI 151LB.] [Cavalcanti RB, et al. and Grinspoon S et al. J Infect Dis .--both Published online , ahead of print (May 2, 2007).] [Mallon PWG et al. Antiviral Therapy 10: L5, 2005.] [Macallan, DC, et al.. 46th ICAAC. Abs H-1897.] ] Agents studied to try to increase fat Results Rosiglitazone Minimal effect and may hurt heart by raising cholesterol and triglycerides Pioglitazone In one study pioglitazone raised limb fat but only in those NOT taking Zerit (stavudine, d4T) Pravastatin Fat gains shown but the study was small, and of short (12W) duration Uridine NucleoMaxx® is EXPENSIVE! Fat gains shown but the study was small, and of short (12W) duration Human Growth Hormone Makes fat loss worse
  • Surgical options - facial restoration
    • There are currently several treatments to restore the appearance of the face
    • These products are facial fillers that correct the symptoms of lipoatrophy
    • They do not correct the cause of the problem: fat cell destruction
  • Commonly-used options for HIV-related facial lipoatrophy Table provided by PoWeR (Program for Wellness Restoration) and www.facialwasting.org. Source: Comparison of Poly-L-lactic Acid and Calcium Hydroxylapatite for Treating Human Immunodeficiency Virus-Associated Facial Lipoatrophy; Cosmetic Dermatology, May 2007, Vol 20 No. 5 PRODUCT TYPE/SESSIONS FDA APPROVED? COST Sculptra (Poly-L-lactic acid) Non-permanent/ several sessions needed Yes Patient assistance for product only (under $40,000/yr income: www.needymeds.com/papforms/ sculpt1039.pdf ). Labor cost avg. $400 per session. Full price: $1100 per session for product. Radiesse (Calcium hydroxylapatite ) Non-permanent/ several sessions needed Yes Patient assistance for product only (under $80,000 a year w/sliding scale). Labor avg. $400 Full price: $1200 per session. Silikon 1000 (Purified polydimethyls-iloxane ) Permanent/ several sessions needed Off label use: FDA approved for intraocular injections to treat CMV- related retinal detachment No patient assistance available. Full price: $800 per session.
  • Commonly used options for HIV-related facial lipoatrophy (2) Table provided by PoWeR (Program for Wellness Restoration) and www.facialwasting.org. Source: Comparison of Poly-L-lactic Acid and Calcium Hydroxylapatite for Treating Human Immunodeficiency Virus-Associated Facial Lipoatrophy; Cosmetic Dermatology, May 2007, Vol 20 No. 5 PRODUCT TYPE/SESSIONS APPROVED? COST PMMA-polymethylmethacrylate Permanent/ 1-2 sessions needed Not FDA approved: Mexico, Brazil $1200 avg total cost Autologous fat transfer: fat pulled from one spot in the body and injected into the face Non-permanent/ several sessions needed FDA approved $3,000 avg total cost Hyaluronic Acid (Restylane, Perlane, Hylaform) Permanent/ several sessions needed Only Restylane is FDA approved Approximately $1,500 per visit Polyalkylimide ( Bioalcamid) Permanent/ several sessions needed Not FDA approved: Europe, Canada, Mexico, others $4,500 avg total
  • Before After
    • The hope is that the results will be visible and safe
    • There is risk of infection and unwanted results with all facial fillers
  • Reconstructive therapy recommendations: DHHS 2006 [DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents 2006] Adverse effects Fat maldistribution Causative ARVs PIs; d4T Onset /clinical manifestations
    • Onset : Gradual: months after initiation of therapy
    • Symptoms :
    • Lipoatrophy: peripheral fat loss manifested as facial thinning, thinning or extremities and buttocks (d4T)
    • Increase in abdominal girth, breast size, and dorsocervical fat pad (buffalo hump)
    Estimated frequency High: exact frequency uncertain; increases with duration on offending agent Risk factors Lipoatrophy: low baseline body mass index Prevention/Monitoring None to date Management
    • Switching to other agents may slow or halt progression; however, may not reverse effects
    • Injectable poly-L-lactic acid for treatment of facial lipoatrophy
  • Butt-enhancer pants
    • Padded shorts are designed to
      • Make sitting less painful
      • Fill out clothing and give a more “normal” rear view
  • Butt pants add back
    • Male and female versions available
    • Cost $35-$40
  • What have we learned?
      • It is better to avoid fat loss in the first place with careful anti-HIV drug selection than to try to fix it after it’s gone: The NRTI, Zerit (stavudine, d4T)—and to a lesser extent, Retrovir (zidovudine, AZT)—are to be avoided, if possible.
      • Some anti-HIV drugs are more fat-loss friendly than others: Viread (tenofovir), Ziagen (abacavir), Kaletra (lopinavir/ritonavir) have all shown little—or significantly less—fat loss than the drugs they were compared to in recent studies
      • Switching Zerit or Retrovir to fat-loss friendly NRTIs can help restore some fat, but a return to “normal” isn’t happening
      • Use DEXA scan to assess for fat loss (or fat gain) early on and later in therapy. It’s good to have results from different time periods to compare
      • There are patient assistance programs available to help with cost of two facial filler treatments
  • Tips to assist patients
    • Always ask healthcare providers to do his/her homework (you do some too!) before choosing various therapies
    • Be sure to continue to find ways to obtain up-to-date information and resources related to fat loss, and share the info with others
  • Patient–provider communication
    • Taking anti-HIV therapy when and how it is supposed to be taken is a key part of HIV treatment success
    • Healthcare providers should address all stigma-related issues (including fat loss) when counseling patients before antiretroviral treatment is started
  • Patient–provider communication (2)
    • Counsel patients about when to start or change anti-HIV treatments
    • Listen to patients’ concerns and assist them in finding the anti-HIV medicines that best fit their needs
    [Rintamaki L, Davis T, et al. AIDS PATIENT CARE and STDs, Volume 20, Number 5, 2006]
  • Resources
    • For more lipoatrophy and HIV–related info:
    • Search term for Internet: HIV lipoatrophy 2007
    • www.thebody.com
    • www.aidsmeds.com
    • www.thewellproject.com
    • www.aids-etc.org
    • For more info on padded undershorts:
    • www.buttforyou.com
    • www.lipowear.com
    • For providers: Lipodystrophy Case Definition webtools
    • www.ti3m.com/hiv/default_ld.htm
  • Resources (2)
    • For more info on facial fillers:
    • www.facialwasting.org
    • www.sculptra.com
    • www.thebody.com/lipo/sculptura
    • www.jromano.com
  • The What, the Why, and the How of Lipoatrophy in HIV Legal Disclaimer The material presented here does not necessarily reflect the views of Visionary Health Concepts or companies that support educational programming on www.freehivinfo.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity. Copyright © 2007 Visionary Health Concepts
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