The regimen dramatically reduced patients' viral loads and was well-tolerated, he says. Other researchers are exploring the use of a pair of nonnucleosides with one other drug, and Cohen hopes that combination may circumvent lipodystrophy problems. If the fat problem is limited to central fat accumulation, exercise may help, she says, but it is unlikely to help if the problem involves loss of fat in the extremities. Similarly, Serostim, recombinant human growth hormone, has proven useful helping patients shed fat, but if the patient also has a problem with peripheral fat loss, growth hormone will exacerbate it. Growth hormone also has the potential to cause glucose intolerance, so it is not recommended for people with clinically significant insulin resistance.
Metformin is sometimes helpful with diabetes and fat accumulation.
But metformin causes fat loss everywhere, Mulligan adds, so, like Serostim, it has the potential to exacerbate peripheral fat loss. Another problem with metformin is that it can cause lactic acidosis, so people with increased lactate levels or impaired kidney function should not use the drug, Mulligan says. Of all the fat distribution problems, peripheral fat loss and facial fat atrophy are the most troublesome to deal with. There is some evidence suggesting nucleoside analogs may contribute to the problem, Mulligan says. However, the study is controversial and awaits independent confirmation.