Treatment Update from Seattle: part one
(VLDL). This type does not stick, but on the contrary forms
particles in the blood that 'hoover up' lipids and transport them to
the liver for reprocessing.
One in six had both VLDL and LDL. This pattern is seen in people who have
genetically inherited high cholesterol - and they do not always have more
heart problems.
There are more obvious effects of lipid change, like facial and limb wasting
(lipoatrophy) and 'protease paunch' (fat accumulation). Australian lipo
specialist Andrew Carr produced promising results in 111 patients with
lipoatrophy by changing the d4T (or in some cases AZT) in their initial
regime to abacavir. After 24 weeks, the
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abacavir patients had put on an average of 1lb (0.4kg) of fat on their
limbs, the non-switching patients almost none.
Carr commented: "At this rate, it might take seven years to reverse
lipoatrophy", Carr's patients had 'moderate' lipoatrophy, and switching
might have a quicker effect if done earlier.
Why not use abacavir routinely? Abacavir's properties have been obscured
by the fact that it has tended to be used as a 'second-line' drug, except
when its manufacturers, GlaxoSmithKline, bundle it alongside AZT and 3TC
in the combo pill Trizivir. Time, maybe, to drop the AZT and use abacavir
or maybe tenofovir plus 3TC in a standard first combo.
You can't measure lipodystrophy or how to cure it till you have a consistent
definition
of it. Carr's colleague David Cooper has devised a test that produces an
