Lipodystrophy – body fat changes

Researchers confirmed this week that the use of modern HIV drug regimens is not associated with the loss of fat in the arms and legs. In fact, people tend to gain fat in their limbs, perhaps because their general health is improving.

‘Lipodystrophy’ is a medical term referring to changes in body fat and is a side-effect of some HIV treatments. Lipodystrophy includes both fat gain (for example, around the waist) and fat loss (for example from arms and legs, which makes the veins more prominent).

American researchers followed 269 people who were starting HIV treatment for just under two years. People were randomly assigned to one of four different combinations of anti-HIV drugs. The drugs used included abacavir and 3TC (in the combined pill Kivexa); tenofovir and FTC (in the combined pill Truvada); efavirenz (Sustiva); and ritonavir-boosted atazanavir (Reyataz).

At the end of the study, body scans showed that limb fat levels had increased by an average of 23%. People taking atazanavir gained more fat on their limbs than people taking efavirenz. People who had a higher viral load to start with gained more fat, suggesting that they put on weight as their overall health improved.

Only 5% of people lost more than 20% of their limb fat.

The researchers say that their results provide reassurance that Kivexa and Truvada do not cause fat loss. Older drugs such as d4T (stavudine, Zerit) and AZT (zidovudine, Retrovir) are associated with much higher rates of fat loss.

However the study did find that people in the study did also gain weight around the waist, including increases in ‘visceral fat’. This is fat which accumulates around the internal organs, causing the belly to feel taut and pushed out; it is the kind of fat gain which may be a drug side-effect.

Increases in visceral fat were larger in people taking the protease inhibitor atazanavir (boosted with ritonavir) than in people taking efavirenz. Greater increases in visceral fat were also more common in people who were fatter to begin with.

If you are concerned about any side-effects you are experiencing, or concerned about the possible side-effects of a drug you are taking, talk to your doctor or another member of your healthcare team.

You can find out more about dealing with side-effects in NAM’s booklet Side-effects. It is available on our website in English, Dutch, French, German, Hebrew, Norwegian, Polish, Russian, Spanish and Swedish.

HIV treatment and premature ageing

Based on an exploratory study, scientists said this week that some antiretroviral drugs could be linked to premature ageing. While the drugs mentioned are no longer routinely used in the United Kingdom, the study suggested that the link could still be seen in people who had taken one of the drugs in the past but were now taking modern treatment.

There is some evidence of accelerated ageing in people with HIV, including more frailty, a loss of lower-limb strength, modest declines in physical function, and declines in limb muscle.

Some scientists argue that some of this is caused by the long-term accumulation of mutations in the body’s cells. Specifically, they say that mutations in part of the cell known as the mitochondrial DNA are important.

Moreover, some antiretroviral drugs, belonging to the NRTI class (nucleoside reverse transcriptase inhibitors), can cause mutations in mitochondrial DNA and depletion of mitochondrial DNA. The older NRTIs d4T (stavudine, Zerit), ddI (didanosine, Videx) and AZT (zidovudine, Retrovir, also in Combivir) have this effect.

The NRTIs which are prescribed today (for example, in Kivexa and Truvada) have little effect on mitochondrial DNA.

In a small study, scientists observed differences in the cells of HIV-positive people who had taken treatment, as compared with HIV-positive people who had never taken treatment and with HIV-negative people.

The extent of the changes was linked to how long people had spent on treatment. Some people under the age of 50 had cell changes more commonly seen in people aged 80 or above.

However not all scientists agree that these mutations and cell changes are the principal cause of ageing. Also, the findings need to be validated in larger studies.

It is important to remember that any form of antiretroviral therapy is highly beneficial for people with advanced HIV infection, even if it includes older drugs such as AZT.

‘Positively Old’ was the subject of the British HIV Association (BHIVA) annual community symposium. You can read our report from that meeting, The prescription for old age, on our website. For more news and features on the subject, visit our topic page on ageing.

Giving up smoking

People with HIV tend to be more likely to smoke than people in the general population and smoking-related diseases are a major cause of illness and death in people with HIV. But surprisingly little research had been conducted with HIV-positive smokers into programmes to help them quit smoking.

Now a study has found that a mobile phone counselling service can help people with HIV to stop smoking.

Researchers in an urban part of Texas recruited 474 HIV-positive smokers who wanted to quit. Most people taking part were socially disadvantaged.

Everybody received brief advice about how to stop smoking, written information and nicotine replacement therapy (such as patches or gum). Half the group received no further support, while the other half were given a mobile phone, eleven counselling sessions over the phone and a hot-line number to call at other times.

Smoking rates were measured after three months. Amongst those who didn’t get more support, just 2% managed to quit, but this rose to 9% in those who had phone counselling.

The study suggests that more needs to be done to help this group give up smoking, but that support over the phone could be part of the solution.

If you want to give up smoking, talk to your doctor or another member of your healthcare team about the support available to you. In the UK, most NHS trusts offer support with stopping smoking. You can call the NHS Stop Smoking Helpline on 0800 022 4 332 or visit the NHS website www.smokefree.nhs.uk.

Post-test counselling

Researchers in the United States who were concerned about the number of people who test positive for HIV and don’t stay in touch with medical services have found that poor post-test counselling may sometimes be to blame.

The researchers conducted in-depth interviews with people who’d been diagnosed with HIV in the past year or two, but who hadn’t seen an HIV doctor since.

A common theme of the interviews was that little post-test counselling was provided or that it was of poor quality. Some counsellors were not perceived to have been caring or compassionate. Some people felt that they had been given incorrect or incomplete information, leading them to lose trust.

The healthcare system is complex in the United States, particularly for people on low incomes, and this created barriers to people having their HIV treated. The social workers who were meant to help people navigate this system didn’t always seem to be helpful or easy to get hold of.

The researchers recommend better support for people who have just tested HIV-positive, including more thorough counselling and stronger links between testing and follow-on services.