During a talk on lipodystrophy at the Pacific Design Center on May 13, Gary Cohan, M.D., of Pacific Oaks Medical Group said that between 5 and 64 percent of people on protease inhibitor therapy have increases in truncal fat. Dr. Cohan indicated that there seemed to be an unmasking of underlying metabolic abnormalities associated with decreases in HIV production. Cohan noted that most people who develop these metabolic changes seem to be those benefiting from antiretroviral therapy. Cohan offered some possible treatments for lipodystrophy. While anabolic steroids are used by some physicians to treat lipodystrophy, not all physicians would recomend this practice to their patients, as increased triglygeride levels are a side effect of steroids.
Experts also disagree as to whether stopping or changing antiretroviral therapy is a good idea.
Though not true in every case, there are several reports of lipodystrophy reversal following discontinuation of therapy. Additional medical evidence suggests that growth hormone has reversed lipodystrophy in two people. Lastly, Cohan and others agree that treatment of diabetes and high triglyceride levels is important. While there is much discussion of lipodystrophy and other metabolic changes among physicians and researchers, there are not many concrete answers. Whether these abnormalities are a direct side effect of protease inhibitors or of mere combination therapy or if these abnormalities are already present to a lesser degree and enhanced by the reduction of viral load is not clear.