November 12, 2010
That's the debate that seems to go on a fair bit among people who have a lot of fat gain and then decide to resort to liposuction, for instance, instead of a diet or nutrition or exercise change in order to resolve the problem.
But when we're talking about this particular type of fat gain, doesn't this tend to be something that people don't really have much control over?
Well, true, certainly if it's due to their HIV infection and due to medication, there is a certain amount of non-control in terms of fat accumulation developing. But I strongly believe that individuals who maintain exercise regimens, who subscribe to a diet such as the Mediterranean type of diet, have a lot less potential for developing the problem in general. They can develop lipoatrophy, in other words, loss of fat. But in terms of lipo-accumulation, I believe that they're less likely, or the severity of what they'll see will be much less than seen otherwise because from just the logical sense: If you're exercising normally, you're going to be burning body fat, oxidizing fatty acids. Your body's going to be working more metabolically efficiently and you'll be using your nutrients more efficiently. Your cells and mitochondria will be working more efficiently.
So then to take a step back, we're looking at a situation where we still have people developing or continuing to have this excess belly fat, this visceral adiposity that you had mentioned. And we suddenly have this new option on the table that can be used to potentially treat it, at least in part.
So for you, as an HIV doctor, what would you recommend for your HIV-positive patients who might be developing fat gain, or who might want to avoid it in the first place? Does it start with diet and nutrition? Is that what you focus on and only resort to Egrifta later on? Or is there a point at which you're like, "You know what? I know this person's been on treatment for 10 years. They've had this for a while. I should just start them on this immediately"?
I think it's going to be patient-specific, knowing your patients and taking them as individuals. So for a patient who has lousy eating habits and doesn't exercise, obviously you want to target them, you want to get them to get into better habits. And also, as I mentioned earlier, we're always looking at the overall benefit in terms of reducing cardiovascular risk for our patients. So that's very much consistent with that line of thinking.
As you said, say you have seen a patient for several years and you've already talked to him or her about a diet, or you know that the patient is not going to be good at that -- just by understanding the patient's personality and habits -- I think that it's then reasonable to try Egrifta. But again, I always believe that we should be counseling our patients in terms of diet and exercise wherever possible.
Also, in terms of reducing cardiovascular risk, if patients have elevated lipids, [then recommend they go] on a statin, for example; if they're a smoker, try to help them to try to quit. All of that is part of trying to reduce the long-term complications that are now being seen in people with HIV as they live longer.
I think that Egrifta is an option for patients that have visceral adiposity. You can use it as first line, or you can use it in combination with some dietary habits or for people that are not going to effectively change dietary habits. I think Egrifta is an option. And I think it's going to be widely used.
Yes, and we'll see how things pan out, particularly over the long term as people begin to use it more frequently.
Daniel Berger is the medical director and the founder of NorthStar Medical Center in Chicago. He's also a clinical associate professor at the College of Medicine at the University of Illinois at Chicago. Dr. Berger, thank you so much for taking the time to talk to us.
This transcript has been lightly edited for clarity.
Myles Helfand is the editorial director of TheBody.com and TheBodyPRO.com.
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