Current perspectives on the management and prevention of antiretroviral-associated lipoatrophy

Courtyard Clinic, St George's Hospital NHS Trust, Blackshaw Road, Tooting, London SW17 0QT, UK.
Journal of Antimicrobial Chemotherapy (Impact Factor: 5.31). 09/2008; 62(5):866-71. DOI: 10.1093/jac/dkn318
Source: PubMed

ABSTRACT Lipoatrophy (LA) is a common and now well-recognized complication of highly active antiretroviral therapy (HAART). Over the last decade as knowledge of the mechanisms behind LA has developed, several antiretroviral drugs, in particular, have emerged as the likely agents responsible for this complication. This has been supported by studies comparing alternative HAART regimens and by those in which HAART regimens have been modified with a resulting impact on LA. In this article, we review the evidence underlying the current perspectives on the development of LA and the strategies employed to manage or avoid it.

7 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ex vivo experiments have been conducted through excised lamb rib cages, with bone, cartilage, muscle and skin. The ribs were placed between a hydrophone and a programmable sparse array made of 200 high power transducers working at 1 MHz central frequency. First, adaptive focusing through ribs has been experimentally studied at low power. Without any correction, the pressure fields in the focal plane were affected by both inhomogeneous attenuation and phase distortion and three main effects were observed: a mean 2 mm shift of the main lobe, a mean 1.25 mm spreading in the half width of the main lobe and up to 20 dB increase in the secondary lobe level. Three adaptive focusing techniques were tested with continuous waves: phase shift, time reversal and time reversal coupled with amplitude compensation. We show that time reversal is more appropriate, as it minimizes the heating of the ribs by naturally sonicating between the ribs. It is also shown that a non invasive technique could be implemented by using the imaging capabilities of the therapeutic array.
    Ultrasonics, 2003 IEEE Symposium on; 11/2003
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to determine whether statin exposure in antiretroviral-treated individuals is associated with increases in hip circumference compared with HIV treatment without concomitant statin use. This was a prospective multicentre cohort study involving individuals who had received antiretroviral therapy for at least 40 weeks and who were enrolled in the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. There were 2,223 participants in the statin-unexposed group and 371 in the statin-exposed group. The main outcome measure was change in hip circumference at week 32. The 32-week change in hip circumference in the statin-exposed group was 0.60 cm greater (95% confidence interval 0.11-1.10; P=0.02) than in the statin-unexposed group after adjustment for age, gender, race, baseline body mass index and thymidine analogue exposure. Our findings support the hypothesis that statins might be beneficial in lipoatrophy. Given the limited treatment options for this important problem, further studies are needed to confirm this effect and to determine its clinical significance.
    Antiviral therapy 01/2009; 14(6):853-8. DOI:10.3851/1300 · 3.02 Impact Factor
Show more


7 Reads