Working to ease HIV side effect
Three new studies indicate that it may be possible to avoid many of the fat-distribution problems associated with HIV drug therapy, giving patients a better quality of life and minimizing risk to their hearts, researchers said Monday.
The introduction of powerful drug cocktails in the 1990s was a major breakthrough in HIV therapy, permitting patients to survive indefinitely.
But it was accompanied by an unanticipated side effect -- a rearrangement of body fat that produced a withering of the arms and excessive accumulations of fat in the abdomen, back and neck, often referred to as buffalo hump.
In addition to the aesthetic problems, the changes altered cholesterol levels, potentially increasing the risk of heart attack and stroke.
Researchers at the Conference on Retroviruses and Opportunistic Infections at the Los Angeles Convention Center reported that many of the problems could be avoided by judicious use of an experimental drug, an existing AIDS medication and a widely used cholesterol-lowering agent.
“The message is a lot of work is going on to try to optimize treatment for the long haul,” said Dr. Judith Currier, a professor of medicine at UCLA who was involved in one of the studies.
Dr. Steven Grinspoon of Massachusetts General Hospital reported on an ongoing study of an experimental drug called TH9507 that stimulates the body to produce a growth hormone, which burns off excess fat.
He studied 412 patients, half of whom received the drug in addition to their regular HIV therapy and half of whom received a placebo. The drug, manufactured by Theratechnologies Inc. of Montreal, reduced the buildup of fat in the abdomen and back by 15%.
Such buildup can be a serious problem, said Dr. Curtis Cooper of the University of Ottawa, because it often leads patients to abandon their drug regimen.
The drug also reduced blood levels of triglycerides -- a major component of cholesterol -- by 18%.
The cholesterol-lowering drug ezetimibe -- sold by Merck & Co. and Schering-Plough Corp. as Zetia -- gives doctors another option, said Dr. David Wohl of the University of North Carolina at Chapel Hill. He studied 48 patients, half of whom received Zetia in addition to their normal regimen.
Those who received the drug had a median 12% drop in low-density lipoproteins, the so-called bad cholesterol, while those receiving a placebo had a 3% increase. The study was funded in part by Merck.
In the third study, Dr. D. William Cameron of the University of Ottawa looked at two groups of HIV-positive patients who had previously received no treatment.
One of the groups initially received the Abbott Laboratories combination drug Kaletra in a cocktail with other drugs, then only Kaletra. The second group received a standard regimen.
Of those receiving Kaletra, 5% developed abnormal fat distribution, specifically the loss of fat in their limbs. In the comparison group, 34% suffered from the abnormal distribution, Cameron said.
Dr. Julian Falutz, director of the HIV Metabolic Clinic at McGill University in Montreal, said the presentations did not prompt him to make immediate changes in drug treatment, but he was encouraged by the data.
“I thought there were a lot of very positive results, which points out that people are taking metabolic issues very seriously and minimizing these complications,” he said.