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project iNform | pi perspective | issue 48 | march 2009
cancers may be increasing in people living with HIV in later years. The wider availability of HIV therapy did not make impact the risk of developing these cancers.
This early report helps to further define cancers of concern for more focused research in HIV. Also, stronger immune systems due to HIV therapy may prevent developing certain infection-related can- cers, notably cervical/anal cancers and Hodgkin's disease. In addition to routine monitoring of HIV disease, people living with HIV should diligently explore their cancer risks and screen appropriately.
N e w s o N h i v r e l a t e d c o N d i t i o N s
limb fat wasting improves with rosiglitazone therapy
The drug for treating diabetes, rosiglitazone (ROSI) improved lipoatrophy and insulin levels in people not taking thymidine NRTIs, which include Retrovir (AZT, zidovudine) or Zerit (d4T, stavudine). ROSI works by increasing the activity of a specific cell protein (called PPAR-gamma) that helps to break down fats in the body. Thymidine NRTIs significantly inhibit PPAR, and thus can cause changes in fat distribution, such as fat loss, called lipoatrophy.
This double-blind study followed 71 people with lipoatrophy. All stopped their NRTIs at least 24 weeks before study entry, although the average length was 4 years. They were randomized to take either 4mg ROSI twice a day or placebo for 48 weeks. DEXA scans (to measure fat content and bone density) and fasting metabolic tests (to measure insulin levels) were done throughout the study. Facial fat loss was not evaluated in this study.
Women made up 17% of the study participants, average age was 50 years, and 51% were white. About 92% of people had viral loads below 400, and characteristics at study entry were similar be-tween the groups. Average limb fat was ~6500g for ROSI group and ~6400 for placebo. Volunteers could display some amount of insulin resistance, but those with diabetes were excluded from the study.
The results showed that the ROSI group had more significant increases in limb fat on average by 911g vs. 253g on placebo. The percentage of gained limb fat was also higher in ROSI group at 15% vs. 5% on placebo. Triglycerides and cholesterol levels did not change significantly within or between the groups. As well, lipid levels and bone density were not affected by ROSI therapy. According to the researchers, ROSI significantly improves lipoatrophy in people not on a thymidine NRTI. Though ROSI may be a promising therapy for improving lipoatrophy, people on thymidine NRTIs may do best by changing to a regimen without these NRTIs before adding ROSI therapy to their HIV health care. N e w s o N h i v r e l a t e d c o N d i t i o N s
a person's modifiable risk factors nearly
double their risk of non-aids death
Data from the D:A:D study showed that factors which people can change and influence nearly double the risk of non-AIDS death. These medical and lifestyle issues include smoking, high blood pressure and diabetes.
The D:A:D (Data collection on Adverse events of anti-HIV Drugs) is a large observational study examining the safety of HIV drugs and health outcomes of those on therapy. Just over 33,000 people were enrolled. Average age was 39, most were men (74%), 45% were white, more than half were NatioNal hiv/aids treatmeNt hotliNe 1-800-822-7422 www.projectiNform.org support@projectiNform.org
project iNform | pi perspective | issue 48 | march 2009
either current smokers or had smoked, 34% had HBV or HCV disease, and 3% had diabetes. At the start of the study, about 3 out of 4 were taking therapy. Average CD4 count was 408 and average viral load was 1,000. The length of time on HIV therapy averaged just over 3 years.
People were evaluated from the time they entered the study until their last follow-up visit (or death) through October 2007. Body mass index (low weight), blood pressure, diabetes, smoking, use of therapy, and current CD4 counts and viral loads were studied.
A total of 2,192 deaths occurred during the period studied. Underlying causes of death included AIDS (32%), liver disease (14%), non-AIDS cancers (12%), heart disease (11%), bacterial infec- tions (9%), non-natural deaths (9%), and other causes (13%.) The results showed the following: • Lower CD4 counts were associated with a higher risk of death from al specific causes of death.
• Higher current HIV RNA was a risk factor for AIDS-related and liver-related deaths overal • HIV levels above 400 when on therapy raised the risk of death from al causes while HIV levels above 10,000 when off therapy greatly raised the risk for all causes of death.
• Diabetes was associated with al specific causes of death except non-AIDS cancers.
• Smoking was a risk factor for heart disease and non-AIDS cancers.
• HBV and HCV co-infection were related to liver-related deaths, and HCV raised the risk of • Low body weight correlated to a 3-4 times higher rate of death and non-AIDS cancers.
• Hypertension was a 2-3 times higher risk factor for liver-related and heart disease deaths.
Many of these, if not al , are not radical y unknown risks for death in the general population let alone people living with HIV. However, the degree to which these factors increase the risk of death in HIV-positive people is striking. Given that people, with or without HIV, can make constructive changes to impact some of the issues that increase risk of death, it's important for people to take a proactive role in addressing what they can to prolong and improve their quality of life.
Changes that people may do to reduce risks include: • Get tested for HBV and HCV. If you test positive for HBV or HCV, discuss your options with your health provider and follow through with a treatment plan.
• Get the HBV vaccine if you test negative and haven't already had the disease.
• Ensure your current HIV therapy is working as wel as it can at keeping your CD4s as high as possible and your viral load undetectable for as long as possible.
• Get routine lab work done and go to scheduled appointments.
• Improve and maintain proper adherence to HIV drugs and meds for other infections.
• Explore smoking cessation programs and stop smoking.
• Eat a balanced diet low in saturated fats and sugars.
• Watch weight and nutrition with the same careful eye as CD4 counts and viral load. Any un- planned weight loss is undesirable (regardless of whether or not it's welcomed).
• If you're diabetic, keep diabetes under control with the proper medications and check-ups.
• Find ways to lower your stress level and to exercise at the level you can.
• If you have high cholesterol, consider lipid-lowering drugs or HIV therapy that has fewer • Consider ways to build more lean body mass.
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Source: http://www.aidsactionbaltimore.org/articles/pip48y.pdf