Lipodystrophy in HIV Disease Video Transcript

Participants

David L. Butcher M.D., Gary R. Cohan MD, Donald P. Kotler MD, Graeme Moyle MBBS, MD

Summary

Lipodystrophy is a condition that many people with HIV develop. Their appearance can change dramatically and they may experience dangerous cholesterol levels. In this webcast, learn more about this recently recognized syndrome, its possible causes, and how it is linked to long-term HIV survival.

Webcast Transcript

ANNOUNCER: Lipodystrophy is a condition that many people with HIV experience in which there are unusual changes in the distribution of body fat.

GARY R. COHAN, MD: Many of these patients will lose fat in the face so that in the cheeks they have a sunken cheek appearance. Sometimes they also lose fat or soft tissue in the temples.

GRAEME MOYLE, MD: People tend to notice it particularly on their legs first and on their arms, where you start to see a pseudo-athletic appearance because you lose fat, the muscles become more evident although not necessarily any bigger.

DONALD KOTLER, MD: Some patients in addition will have thickening of and an enlargement of a fat pad in the back of the neck, so they look like they have a hump. As a matter of fact, it's called a buffalo hump.

GARY R. COHAN, MD: They tend to have an enlarged belly. It almost looks in some patients like they've got a bowling ball in there, like they're pregnant.

ANNOUNCER: The psychological impact of these body changes can be enormous.

GRAEME MOYLE, MD: In some individuals, with more severe changes, often you see people genuinely becoming depressed, becoming socially withdrawn.

DAVID L. BUTCHER, MD: People feel like they can't go out in public without someone looking at them that's familiar with HIV disease and treatment and saying, "Aha, there's someone with HIV."

ANNOUNCER: In addition to unusual weight gain and loss, patients with lipodystrophy often have elevated blood levels of cholesterol and triglycerides. And those changes can be life threatening.

DONALD KOTLER, MD: The medical condition associated with lipodystrophy is that of an increased risk of accelerated atherosclerosis, hardening of the arteries, an increase in the risk of having heart attack and stroke.

ANNOUNCER: People with lipodystrophy can also develop insulin resistance. And although it is rare, patients can experience a dangerous build up in the blood of a metabolic byproduct called lactate.

GRAEME MOYLE, MD: So the consequences of losing a lot of fat in the short term may be largely cosmetic, socially stigmatizing, psychological. In the longer term, they may also have implications for other illnesses further down the track -- heart disease, potentially pancreatitis and diabetes with its complications.

ANNOUNCER: The condition now known as lipodystrophy, emerged only recently as effective HIV therapies became available in the late 1990's. Doctors started seeing the high blood lipid levels and the changes in body fat in patients who otherwise were quite well.

DAVID L. BUTCHER, MD: The cause of lipodystrophy is still unknown, to be very brief and very blunt. Now, there are certain aspects of the syndrome that are clearly related to the drugs that we use.

ANNOUNCER: Protease inhibitors, one of the important categories of HIV medication, have been linked to some aspects of lipodystrophy, especially the elevated levels of cholesterol and triglycerides.

Other HIV medications have also been associated with the condition.

GARY R. COHAN, MD: Other associations between antivirals and lipodystrophy are between the nucleoside analogs and loss of fat. And there are a number of drugs that seem to be blamed more than others for loss of fat but when you really look at the data, the whole class of drugs may actually cause some toxicity. So we're really not sure what's causing all this lipoatrophy, but it turns out it may or may not be related to medications or the medications may accelerate an underlying process.

ANNOUNCER: To look for other possible risk factors, a large study - the HIV Outpatient Study, or HOPS surveyed thousands of patients.

GARY R.