New Treatment Reduces Big Bellies Associated with HIV Treatment

You have been on HIV medications for a few years, and your provider tells you that you are doing well.  Your CD4 is up, your viral load is low or undetectable, and you should be feeling great.  But you don't, because you have a protruding abdomen from lipodystrophy associated with HIV and its treatment.  You have tried dieting and exercise, but your tummy does not bulge.  You worry that everybody looks at you and says, oh, "He has HIV."

This week I am writing about a new treatment for excess abdominal fat in HIV-infected people with lipodystrophy.  It is called Egrifta or tesamorelin.  It’s a daily shot that you give yourself which can reduce the belly fat significantly.  It is not a treatment for HIV.

Egrifta works by stimulating growth hormone receptors in the pituitary to produce growth hormone, which causes muscle growth and breaks up fat.  It is only recommended for reducing excess abdominal fat in HIV-infected persons with lipodystrophy.

The drug was approved by the FDA last year on the basis of two multicenter, randomized, double-blind, placebo-controlled studies in HIV-infected patients with lipodystrophy and excess abdominal fat.  Both studies consisted of a 26 week main phase and a 26 week extension phase.  In both studies, the abdominal fat, also called visceral adiposity, was reduced by 14-18% in patients continuing Egrifta for twelve months.  Improvements in fat in the blood stream, triglycerides, and body image, were also shown.

Tomorrow I will write more about effectiveness of Egrifta.

Egrifta is the only FDA approved treatment for this condition.  If you have a big belly from HIV treatment, you might want to ask your provider about Egrifta.  It is not a weight loss drug, however.

Wishing you health,
Bill

Lose the Big Belly

Ask anyone with HIV what they fear most, and you're likely going to get the answer, "I don't want to look like I have AIDS."  Often, friends and clients tell me, "I don't want to have the sunken cheeks, the skinny arms and legs, lose my butt, and have the protruding abdomen that looks like I have a basketball under my shirt."

Looking like you have HIV can be devastating and debilitating.  Some people may never notice or care, but to others, they have "the look."  It can hold you back socially and professionally.  It can keep you at home when you should be getting out with people.

For persons with this condition, diet and exercise, though recommended, do not usually reduce it much.  That's because the lipodystrophy (change in body fat) that I'm referring to is hard fat that surrounds your internal organs, not a layer of fat on the outside, like love handles.

This week I will be writing about a new treatment for excess abdominal fat inHIV-infected people with lipodystrophy.  It is called Egrifta or tesamorelin.  It's a daily shot that you give yourself which can reduce the belly fat significantly.  It is not a treatment for HIV.

Yours,
Bill

What Medicines are Recommended for Starting HIV Treatment?

This week flew by quickly.  I'm starting a new fellowship to reduce HIV in African Americans, and I'm very excited about it.  I will be telling you about it in weeks to come.  It's with The Black AIDS Institute.  What a great organization!

I wrote about when to start HIV medications earlier in the week.  Today I want to tell you which medications to start.  Actually, these are the recommendations from HIV experts working with the Department of Health and Human Services, and they were just updated.

Here are the suggested regimens for treatment-naive people with HIV, which means no previous HIV medications.

• Atripla, a one pill a day combination of efavirenz/tenofovir/emtricitabine
• Reyataz (atazanavir), boosted with Norvir (ritonavir) and Truvada (tenofovir/emtricitabine)
• Prezista (darunavir), boosted with Norvir (ritonavir) and Truvada (tenofovir/emtricitabine)
• Isentress (raltegravir) and Truvada (tenofovir/emtricitabine)

Only four regimens are preferred.  Does not mean that other combinations cannot be used?  No, and some other regimens are considered alternative or acceptable regimens.  In some instances, a different regimen might be the best one for you.

How does your doctor find the best regimen for you?  First of all, he or she should talk it over with you and find out what's most important to you.  For instance, some people prefer to take a single pill, and this would narrow down your choices immediately.  For others, the ability to take all of their medications once a day is important.  Your provider will also consider your other medications and the possibility for interactions, other health conditions, and your resistance test results.

Have a great weekend, y'all!
Yours,
Bill

I'm still digesting my Easter dinner today, but had a wonderful weekend with my partner and family.

There are a few other instances when you should start HIV medications immediately, no matter what your CD4 count is:

• If you are pregnant, to prevent infection of the baby.
• If you have had an AIDS-defining illness, such as Pneumocystis jirovecii pneumonia (used to be known as PCP pneumonia), wasting syndrome (extreme unintentional weight loss), or Kaposi sarcoma (purple splotches on the skin).
• If you HIV-associated kidney disease
• If you also have hepatitis B and HIV.

Tomorrow:  What are the recommendations medications to treat HIV in someone never on medication?

Have a great Monday!

Yours,
Bill

When to Start HIV Medications, Continued

Today I'm continuing the discussion on when to start ART (antiretroviral therapy) for HIV.  According to most recent US DHHS Guidelines, most people with HIV should start ART.  If your CD4 (helper count) is less than 500, starting therapy is strongly recommended.  If your CD4 is greater than 500, starting is also recommended, although this remains somewhat controversial until more studies are completed.

In addition, if you are over the age of 50, it is now recommended that you start ART regardless of CD4 count.  This is because of a greater risk of non-AIDS complications in this age group.  Additionally, the body's immunologic response to ART may not be as robust in this age group.

• You should also start on HIV medications if you are:
• pregnant
• have a history of an AIDS-defining illness
• HIV-associated kidney disease
• infection with both HIV and hepatitis B.

Tomorrow, more on AIDS-defining illnesses.

Wishing you health!
Bill

When Starting Medications for HIV, When is the Right Time?

Starting HIV medication is a big decision when you are HIV positive.  Some people say start right away, others say wait.  What is the right answer?

The answer is:  It depends!

According to the recently updated DHHS Treatment Guidelines for adults and adolescents with HIV, treatment is now recommended for everyone with HIV, regardless of their CD4 (helper cell) count:

1.  When your CD4  is less than 350, start treatment as soon as possible-evidence clearly supports starting medications.
2.  When your CD4 is 350-500, starting is recommended.
3.  When your CD4 is greater than 500, starting is recommended, although some questions remain.

• In addition, you should start after you have insurance or a way to pay for your medications, because they are costly.  
• You must be ready and committed to taking HIV medications daily-breaks in therapy are not recommended. 
• If you are sexually active, taking HIV medication will reduce the risk that you will transmit HIV to your parter, so this may also influence your decision to start medication.

Talk to your provider about the right time to start HIV medication.  There are other times when you should start HIV medication, and I'll write about them tomorrow.
Yours,
Bill