On behalf of IFARA, Jeff Taylor spoke with Drs. Tebas, Longenecker and Eckard about metabolic issues in HIV. The panel discussed the use of statins to counteract the lipid-raising effects of some HIV medications. Tebas emphasized that "the benefits of statins are very real," while Eckard cautioned that these drugs may increase insulin resistance. Another issue is that the tenofovir pro-drug TAF may be better tolerated, but does not offer the lipid-lowering benefits of tenofovir.
Renal disease as a side effect of some antiretrovirals is a risk factor for heart disease, as Longenecker pointed out. He noted that "the gut clearly is important in pathogenesis," but that the bacteria in a person's body depends on his or her environment. The microbiome in sub-Saharan Africa, for example, might be contributing to HIV inflammation, but no studies on this issue have been conducted there.
Smoking also contributes to cardiovascular disease. However, only about 20% of participants in a European study involving a smoking cessation program successfully quit the habit. Longenecker called for more research on how to get HIV-positive people to embrace a healthier lifestyle, including smoking cessation, improved exercise habits and a healthier diet.
Retrospective studies had shown lipid-lowering effects of vitamin D supplementation in HIV-positive people, but a new prospective trial of high-dose vitamin D in patients starting therapy with tenofovir showed no such effects. These earlier studies were likely biased, Tebas believed, because people taking vitamin supplements tend to be more health conscious in general, with a better diet and more exercise.
Handling metabolic issues in HIV-positive patients requires a "multifactorial solution particularly emphasizing lifestyle modification," Eckard concluded.
Watch the video to learn more:
About the panelists:
Pablo Tebas, M.D., University of Pennsylvania
Chris Longenecker, M.D., Assistant Professor, Case Western Reserve University, Cleveland, Ohio
The video above has been posted on TheBodyPRO.com with permission from our partners at the International Foundation for Alternative Research in AIDS (IFARA). Visit IFARA's website or YouTube channel to watch more video interviews from the conference, as well as earlier meetings.