Physical and Biochemical Changes in HIV Disease (cont.)

Changing therapies and even stopping treatment has only rarely resulted in reversal of these physical abnormalities. Most other management strategies have focused on dealing with the fat accumulation syndromes. For example, diet and exercise does result in some decrease in belly (abdominal) fat. Similarly, many patients have had plastic surgery to remove fat collections around the neck.

Growth hormone injections have also been shown in small studies to reduce fat collections on the back of the neck and in the abdomen. However, growth hormone is expensive, needs to be used continually, and must be used cautiously because of potential toxicities. In addition, antidiabetes drugs that alter the body's handling (metabolism) of fat are being studied in certain patients with increased abdominal fat. The fat loss syndromes that result in sunken cheeks and prominent veins in the arms and legs have been more difficult to manage. Temporary benefits, however, have been seen with various forms of plastic surgery for sunken cheeks.

What is known about the biochemical abnormalities in HIV?

Unlike the physical (morphologic) abnormalities described above, fat (lipid) and sugar (glucose) changes (metabolic abnormalities) appear to be more closely linked to certain antiviral agents, particularly protease inhibitors. These conditions are often managed by changing the HIV therapy or initiating specific treatment for the high cholesterol or diabetes (the high blood sugar).

Many studies are underway to determine: How frequently these biochemical problems occur. Whether they will place patients at increased risk for heart disease or the complications of diabetes in the future. How to best monitor for and treat these biochemical abnormalities when they develop.

In addition, there is a great deal of interest in defining whether these metabolic abnormalities are linked to the physical changes described above. If so, treating the lipid and glucose problems may represent a strategy for preventing or managing the physical changes.

In conclusion, physical (morphologic) and biochemical (metabolic) changes associated with HIV disease and antiretroviral therapy remain poorly understood. Clinicians need to be honest and up front with patients about these unknowns. However, we should avoid the temptation to assume a cause and effect relationship between any associations. Although the physical abnormalities (manifestations) are often devastating for patients, we must not lose perspective. Antiretroviral therapy can and has saved lives. These known benefits of treatment need to be considered along with all potential toxicities when deciding upon the ideal time to initiate therapy for HIV in any given individual.

Medical Author: Eric S. Daar, M.D.
Medical Editor: Leslie J. Schoenfield, M.D., Ph.D.

Last Editorial Review: 3/29/2002