HIV, Heart Disease and Diabetes
Can changing a health-lifestyle or switching different medications help lower one’s cardiovascular and diabetes risk?
Evidence continues to show that HIV does increase the likelihood of coronary heart disease (CHD), stroke and diabetes, with HAART (highly active antiretroviral therapy) contributing, but not as the sole factor. The FRAM study concluded HIV-infected men with fat abnormalities had linked high belly fat (visceral adipose tissue, or VAT) and lower leg fat (subcutaneous adipose tissue, or SAT) to a higher Framingham Risk Score for cardiovascular disease. The study also tied high total fat, upper trunk SAT, and belly fat to a higher risk of diabetes in men and women with HIV.
Today, HIV clinicians are increasingly concerned with managing lipodystrophy’s (redistribution of fat) metabolic syndrome, since it can be life-threatening, particularly in regards to the risk of cardiovascular disease. HIV management in the developed world is not just about eradicating the virus. It’s about whole health and improved quality of life. Simpler medication regimens and symptom management are not the only priorities. HIV treatment now includes strategies to optimize other health outcomes.
The staggering problems of diabetes and obesity in America underline the importance of doing something about metabolic abnormalities early on. In the general population the rate of diabetes has increased dramatically in the last decade. The projection of new diabetes diagnosis is staggering. Metabolic Syndrome is a precursor to diabetes and bodes our strict attention. According to Centers for Disease Control and Prevention, nearly 21 million Americans are believed to be diabetic, 90 million have insulin resistance, and 41 million more are pre-diabetic with elevated blood sugars that could reach the diabetic level if something is not done to curb faulty food and lifestyle habits. This means over 50% of Americans are impacted by the manifestations of insulin resistance, problems with body composition, pre-diabetes and diabetes. Data shows an increased rate of diabetes in HIV. Also, the DAD study and others have shown that there is a slightly increased rate of heart disease in people living with HIV. Health practitioners are turning to more aggressive and early clinical intervention instead of waiting for the manifestations of obesity, heart disease, and diabetes to complicate heath matters.
Associate Professor Katherine Samaras, Head of Garvan’s Diabetes and Obesity Clinical Research Group and senior endocrinologist at St Vincent’s Hospital, has demonstrated that inflammation (typically associated with immune function) plays a much greater role than previously suspected. Her findings were published in the journal Obesity.
"People being treated for HIV tend to lose fat on their arms, legs, face and buttocks and gain it around their abdomen," said Samaras. "’Lipodystrophy’ and those patients with the condition have a cardiac and metabolic risk profile worse than being very obese." She added, "We think that in some way anti-retroviral drugs influence fat cells, making them push out inflammatory molecules that contribute to creating the heart disease and diabetes we see in patients."
Although lifestyle changes like exercise and proper nutrition strategies are the preferred choice and improve results, diet and exercise alone may not be completely effective. The combination of proper nutrition, weight bearing exercise, and metformin may ultimately be most effective. U.S. guidelines prioritize lifestyle changes over drug switching, cardiovascular or lipid lowering therapy.
http://www.natap.org/2008/CROI/croi_68.htm
http://www.thebody.com/content/treat/art1034.html
http://www.thebody.com/content/treat/art1082.html
http://www.medilexicon.com/medicalnews.php?newsid=129607
