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| |  Study On Lipodystrophy Shows Evolving Perceptions By Physicians Treating HIV TORONTO, ON -- September 14, 2000 -- Physicians who treat people living with HIV are less conclusive about the causes of lipodystrophy, a condition that affects some people living with HIV. Seventy-one percent of physicians believe that the causes of lipodystrophy are multifactorial, compared to 53 percent who recalled believing that it was multi-factorial two years ago. Lipodystrophy is a condition characterized by abnormal distribution of fat, which may include an increase in abdominal girth, fat accumulation behind the neck (known as buffalo hump), and/or lipoatrophy (the loss of fat in the face and limbs). The survey results were released in conjunction with the 2nd International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. The survey comprised 300 physicians who had written at least twenty-two prescriptions for HIV medications in the past month and who treat an average of 130 patients. Half of the physicians surveyed were board certified in infectious disease and half were primary care physicians. Physicians estimated that approximately one in five of their patients experienced lipodystrophy. Perceptions of the causes of lipodystrophy have evolved with the advent of new research. Less than two-thirds of physicians now indicate that protease inhibitors are one of the causes, a decrease from nearly three-fourths two years ago. When asked about the contribution of nucleoside analogs, 70 percent of infectious disease specialists believe that nucleoside analogs contribute to lipodystrophy. Responding physicians identified the following other factors as likely contributors to lipodystrophy: the use of non-nucleoside reverse transcriptase inhibitors (NNRTIs, 27 percent), use of nucleoside analogs (33 percent), the length of HIV infection (35 percent), and the time on antiviral therapy (44 percent). Results further confirm the observation that HIV infection itself may be a factor in lipodystrophy. Among responding physicians who have patients never exposed to protease inhibitors, 40 percent reported that their protease inhibitor-naive patients showed evidence of lipodystrophy. Of physicians with patients who had not received any antiretroviral treatment, one in ten had patients who showed evidence of the condition. While physicians have a general understanding of lipodystrophy, no consensus exists on clinical measures used to define lipodystrophy. When questioned, the vast majority of physicians (92 percent) define lipodystrophy as "maldistribution of body fat", "buffalo hump", "thinning of arms and legs", "facial thinning", and/or "increases in abdomen size." Few physicians mentioned metabolic markers when defining lipodystrophy, including only 14 percent who mentioned lipid abnormalities, 7 percent who specifically mentioned changes in cholesterol levels, 3 percent who mentioned diabetes and 2 percent of respondents who mentioned increases in triglycerides. More than half of the physicians surveyed observed a link between a specific HIV therapy and lipodystrophy. The medications mentioned were Crixivan® (indinavir) by 31 percent of respondents, Norvir® (ritonavir) by 20 percent, Zerit® (d4T/stavudine) by 18 percent, Viracept® (nelfinavir) by 8 percent, Fortovase/Invirase® (saquinavir) by 5 percent, Videx® (didanosine) by 3 percent and Retrovir® (AZT/zidovudine) by 3 percent. Most physicians surveyed support the need for additional prospective clinical trials to more clearly define lipodystrophy and its causes. Over two-thirds of physicians suggested controlled trials comparing therapies within a class (i.e., NNRTIs, nucleoside analogues, protease inhibitors), across classes, and with HIV positive patients who are not receiving therapy. Physicians also suggested other types of studies, including analyzing the fat in a person's body, gene studies, metabolic studies, and the use of insulin sensitizers.
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