HIV cocktails cause diabetes

For the 38 million people living with AIDS and HIV, their disease alone causes a daily struggle, not to mention the many complications that arise. Recent research has suggested that one of these complications, diabetes, results not from HIV itself, but from the drugs used for treatment.

A team led by Dr. Todd Brown at the Johns Hopkins Medical Institutions presented findings earlier this year drawn from three years of data that studied 1,278 men enrolled in the Multicenter AIDS Cohort Study.

They found that HIV patients treated with highly active antiretroviral treatment (HAART) were almost five times more likely to develop diabetes than the HIV-free men who did not receive HAART treatment.

Now, because of this study, the Hopkins School of Medicine has established a new clinic that specifically focuses on treating people who develop metabolism problems, such as diabetes, from HAART.

HIV belongs to a class of viruses called retroviruses and it attacks the cells of people's immune systems. A normally functioning immune system produces white blood cells that fight infections that enter the body. HIV patients therefore live at risk of developing infections much more easily than other people do.

Scientists have long been attempting to find a cure for HIV. To date, they have not succeeded. However, scientists have found many drugs that slow the advance of HIV and treat its symptoms.

HAART is not one drug, but a combination of multiple HIV drugs that all act against the disease in different ways.

When HAART made its clinical debut on HIV patients in 1996, many saw it as a miracle drug. It restored the active lifestyle of bedridden people. The number of cases of HIV began to drop drastically, a first since the epidemic began.

However, doctors and scientists perhaps were overconfident in HAART. In the past eight years, the effectiveness of HAART has diminished, as HIV has mutated and changed. In addition, the $60,000 per year that it still costs to receive HAART is a stretch for most patients.

Diabetes is only one of a set of side-effects that patients exposed to HAART can develop. The entire set of problems that the Johns Hopkins team is out to treat is called lipodystrophy and is characterized by a change in metabolism that is not fully understood.

Lipodystrophy causes a build up of fat in some areas of the body, as well as an abnormal loss of body fat in other areas. High levels of fat and sugar in the blood cause these patients to develop diabetes in most cases.

While the changes in body fat themselves are more of a nuisance than an actual danger, diabetes can be life threatening if not treated, presenting a major concern for HIV patients on HAART.

The new lipodystrophy clinic that this Hopkins team has started is one of only a few similar clinics worldwide. It will help patients deal with all aspects of lipodystrophy. Changes in medication and diet will target problems with diabetes and cholesterol. For patients whose body fat changes are causing further complications, plastic surgery and skin treatments are usually considered.

This week, Brown and his Hopkins colleagues will be presenting their ideas at the 6th Annual Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. This workshop aims to bring together experts in the field of lipodystrophy in order to share information and improve understanding of how these metabolic changes occur and why HAART causes them.

According to a report published by the San Francisco Department of Health, about 74 percent of AIDS patients have used HAART at one time.

For these patients, the dilemma is that they must weigh the advantages of HAART with its risks. For some, the complications that result from HAART are worse than the HIV symptoms that they began with.