The What, Why and How of Lipoatrophy in HIV

© Visionary Health Concepts, New York 2007
Released October 5, 2007

About these slides
• Users are encouraged to use these slides in their own
presentations, but we ask that content and attribution not be
changed. Users are asked to honor this intent.
• These slides may not be published or posted online without
permission from Visionary Health Concepts.
Disclaimer
The materials published on the Visionary Health Concepts website
reflect the views of the authors of the VHC material, not those of
Visionary Health Concepts, Inc., the CME providers, or the companies
providing educational grants. The materials may discuss uses and
dosages for therapeutic products that have not been approved by the
United States Food and Drug Administration. A qualified healthcare
professional should be consulted before using any therapeutic product
discussed. Readers should verify all information and data before
treating patients or using any therapies described in these materials.

The What, the Why, and the How
of Lipoatrophy in HIV CEU Information
Accreditation Statement(s): ANCC
Medical Education Collaborative (MEC) is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center‘s Commission on Accreditation.
RNs, LPNs, LVNs and NPs can receive up to .7 contact hours for participation in this
program. This program is cosponsored with Medical Education Collaborative, Inc.
(MEC) and Visionary Health Concepts. Provider approved by the California Board of
Registered Nursing, Provider Number CEP 12990, for .8 contact hour(s).
Joint Sponsor
This activity is joint sponsored by Visionary Health Concepts and Medical Education
Collaborative (MEC). MEC is a non-profit organization that has been certifying quality
educational activities since 1988.
Commercial Support
This activity was made possible by an educational grant from Abbott Laboratories.

Learning Objectives Upon completion of this educational activity,
participants should be able to:
• Recognize the physical symptoms of HIV-associated lipoatrophy
• Assist patients in understanding the way lipoatrophy is diagnosed and treated
• Discuss recent studies related to ART and lipoatrophy
Target Audience
This program is intended for all healthcare providers, including nurses, treating HIV-
positive patients, especially those who are seeking current and comprehensive
information on lipoatrophy.
Purpose Statement
The purpose of this program is to increase and improve patient/provider
communication on the topic of lipoatrophy by providing both a simple, yet
comprehensive, overview of the topic and an update of recent data related to the
topic.

Release & Expiration Dates
Release date: October 5, 2007; Expiration date: October 5, 2008
Instructions for Credit
There are no fees for participating in or receiving credit for this educational activity. This activity was
developed to be completed within the time designated on the title page; providers should claim only those
credits that reflect the time actually spent in the activity. For questions regarding the accreditation of this
activity, please contact Medical Education Collaborative at 303-420-3252.
Follow these steps to earn CEU:
• Read the target audience, learning objectives, and faculty disclosures.
• Study the educational content online or printed out.
• Online, choose the best answer to each test question.
• You many also print out and return the completed test to toll-free fax 800-407-2505.
• To receive a certificate, participants must score at least a 70% on the post test and
submit it along with the credit application and evaluation form to the address/fax
number indicated. Statements of credit will be mailed within 6-8 weeks following the program.
Hardware/Software requirements:
VHConcepts requires version 4.x browsers or higher from Microsoft or Netscape. Certain educational
activities may require additional software to view multimedia, presentation or printable versions of their
content. These activities will be marked as such and will provide links to the required software. That
software may be: Macromedia Flash, Apple Quicktime, Adobe Acrobat, Microsoft Powerpoint, Windows
Media Player, and Real Networks Real One Player.

Faculty Disclosures
The planning committee and faculty members have the following disclosures:
CEU Chairperson
Andrew Carr, MBBS, MD, FRACP, FRCPA
St. Vincent's Hospital; Professor of Medicine, University of New South Wales,
Sydney, Australia
Dr. Andrew Carr has the following relationships to disclose: grants for paid
research, speaker‘s bureau and advisory boards from Abbott Laboratories.
Editor
Maggie Sosa, APRN, BC, AACRN, ACHPNNP
Nurse Practitioner, Broadway House for Continuing Care, Newark, NJ, USA
Maggie Sosa has no relationships to disclose.

Faculty Disclosures continued
Writers
Lillian Thiemann
President, Visionary Health Concepts, Gardiner, NY, USA
Lillian Thiemann has no relationships to disclose.
Deneen Robinson
Savant Consultants, Dallas TX, USA
Deneen Robinson has the following relationships to disclose: stock
ownership: Abbott Laboratories; advisory committee: Bristol-Myers Squibb;
speaker‘s bureau: Gilead Sciences.
Accredited Provider
The employees of Medical Education Collaborative, the accredited provider
for this activity, have no significant relationships to disclose.

In The What, The Why, and The How
of Lipoatrophy in HIV slide set, we’ll:
• Describe what lipoatrophy is, and what it‘s not
• Discuss current studies about lipoatrophy in HIV
• Provide information on surgical and non-surgical treatment of
lipoatrophy

We’ll also:
• Explore the myths (and realities) of fat loss
• Provide tips for better communication with patients
• Point out the differences between lipoatrophy and AIDS wasting
• Review types of body fat changes (lipodystrophy)

Antiretroviral therapy extends life
Percentage of persons surviving through June 2005, by years after
acquired immunodeficiency syndrome (AIDS) diagnosis cohorts
during 1981-2003 and by year of diagnosis--United States
[Centers for Disease Control and Prevention 2005]

WWW.FREEHIV.COM DRUG CHART
Currently-approved HIV medications
Easy-to-print version available at www.freehivinfo.com
NRTI, NtRTI - Nucleoside and or Nucleotide
Reverse Transcriptase Inhibitors (nukes)
Brand name
(generic name, abbreviation)
Picture Year
approved
Retrovir®
(zidovudine, AZT)
1987
Videx® (didanosine; ddI):
buffered versions
1991
Zerit® (stavudine; d4T) 1994
Epivir® (lamivudine; 3TC) 1995
Combivir® (Retrovir + Epivir, CBV) 1997
Ziagen® (abacavir, ABC) 1998
Trizivir® (Retrovir + Epivir +
Ziagen)
2000
Videx® EC (didanosine; ddI):
delayed-release capsules
2000
Viread® (tenofovir DF, TDF) 2001
Emtriva® (emtricitabine, FTC) 2003
NNRTI - Nonnucleoside Reverse
Transcriptase Inhibitors (non-nukes)
Brand name
Picture Year
approved
Viramune® (nevirapine, NVP) 1996
Rescriptor® (delavirdine,
DLV)
1997
Sustiva® (efavirenz, EFV) 1998
Atripla™ (Sustiva* + Viread +
Emtriva),
* Viread and Emtirvia are non-nucleoside
reverse transcriptase inhibitors (NRTIs).
2006
Crixivan® (indinavir, IDV) 1996
Norvir® (ritonavir, RTV) 1996
Viracept® (nelfinavir, NFV) 1997
Kaletra® (lopinavir + ritonavir,
LPV/RTV)
2000
Lexiva® (fosamprenavir, fos-APV) 2003
Reyataz® (atazanavir, ATV) 2003
Aptivus® (tipranavir, TPV) 2005
Prezista™ (darunavir) 2006
Epzicom® (Ziagen + Epivir) 2004
Truvada® (Viread + Emtriva) 2004
Emtriva)
* Sustiva is a non-nucleoside reverse
transcriptase inhibitor (NNRTI)
2006
PI - Protease Inhibitors
Brand name
Picture Year
approved
Invirase® (saquinavir, SQV) 1995
Entry Inhibitors (including Fusion
Inhibitors and CCR5 Antagonists)
Brand name
Picture Year
approved
Fuzeon® (enfuvirtide, T-20) 2003
Selzentry® (maraviroc) 2007

Lipodystrophy (lipo-diss-troh-fee)
• Lipo means fat, and the word dystrophy means abnormal
looking
• A general ―umbrella‖ term that is used to describe various
changes that occur in the body in how it uses and distributes
FAT
• The conditions that fall under the lipodystrophy umbrella can be
very different in cause and effect

Lipoatrophy (lip-oh-aah-troh-fee)
• Lipo means fat and atrophy means shrinkage
lipoatrophy = ―fat loss‖
• Is often seen in people living with HIV who take
anti-HIV drugs
• Also can occur in those with HIV who have never taken
anti-HIV drugs, and in other diseases such as diabetes
or in rare genetic diseases

AIDS wasting is not lipoatrophy
Fat
loss
Weight
loss &
diarrhea
CD4
Count
HIV
under
control?
Associated
with risk of
death?
Affects
looks?
AIDS
Wasting
yes yes Less than
50
No yes yes
Lipoatrophy
(fat loss)
yes no Over 200 yes no yes

Lipoatrophy occurs in fat
under the skin
• Face
• Arms
• Legs
• Buttocks

Lipoatrophy occurs gradually
At first:
• Legs, arms and face appear thinner
• People may like that their cheekbones are starting to stand
out a little and that their body looks a little more ―cut‖
Then, as fat loss continues:
• Skin loosens, becomes thinner
• Bones, veins, tendons and muscles become much easier to see

Examples of lipoatrophy (women)

FRAM Study Group
[FRAM Study Group. J Acquir Immune Defic Syndr. 2005;40:121-131.]
100
80
60
40
20
0
PeripheralLipoatrophy(%)
Belly fat gain Belly fat loss
NoYes
Belly fat loss
Men
(n=425)
Women
(n=183)100
80
60
40
20
0
PeripheralLipoatrophy(%)
Belly fat gain

How many people have lipo?
• Reports vary from as little as 8% to 84%
– Largest studies suggest 40% to 65%
– The estimates are affected by how long people have been
on HIV treatment and what type of HIV medication
• Reported less often in women—10% to 35%, and may be low
due to underreporting.
[Bernasconi E et al. JAIDS 2002;31:50.]
[Young J et al. Antiviral Therapy 2005;10:73.]
[Miller J et al. HIV Med 2003;4:293.]
[Lichtenstein KA et al. 13th CROI 2006; Denver. Abstract #769.]
[Chen D et al. J Clin Enocrinol Metabol 2002;87:4845.]

Cause of lipoatrophy
• Anti-HIV medications are associated with fat loss
• Some anti-HIV medications cause more fat loss than others
[Lichtenstein KA. J Acquir Immune Defic Syndr. 2005; 39:395-400.]
[Jacobson DL, et al. Clinical Infectious Diseases 40(12):1837-1845. June 15, 2005.]
[Parker RA, etal. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV, 2005,
Dublin, Ireland. Abs 4.. Antiviral Therapy 2005; 10:L5]

Families of HIV drugs: Nucleoside reverse
transcriptase inhibitors (NRTIs)
Brand name Generic name Image
Atripla™
(Sustiva* + Viread
+ Emtriva)
efavirienz +
tenofovir +
emtricitabine
Combivir®
(Retrovir + Epivir)
zidovudine +
lamivudine
Emtriva® emtricitabine,
FTC
Epivir® lamivudine; 3TC
Retrovir® zidovudine, AZT
Trizivir® (Retrovir,
Epivir + Ziagen)
zidovudine +
lamivudine +
abacavir
Truvada®
(Viread +
Emtriva
tenofovir +
emtricitabine
Videx® didanosine; ddI
Videx® EC didanosine; ddI
Viread® tenofovir DF,
TDF
Zerit® stavudine; d4T
Ziagen® abacavir, ABC

What are mitochondria?
• Mitochondria are the cell‘s
‗energy factories‘ where sugar
and fat are burned to turn it into
energy
• If mitochondria are damaged, fat
cells start to shrink and then die

Switching anti-HIV drugs
Changefrombaseline(kg)
Week
Switching
NRTIs
d4T/AZT did
help reverse
the fat loss.
However,
there was no
return to
“normal”.
[Carr et al, AIDS 2001]
[Martin et al, AIDS 2004]
[McComsey et al, Clin Infect Dis 2004]
[Milinkovic et al, CROI 2005]
[Carr et al, JAMA 2002]
[Moyle et al, CROI 2005]
[Murphy et al, CROI 2005]
0
0.2
0.4
0.6
0.8
1
1.2
1.4
0 24 48 72 108
MITOX - ABC
RAVE - ABC
RAVE - TDF
TARHEEL
tNRTI to rLPV
d4T4030 - TDF

Families of HIV drugs: Non nucleoside
reverse transcriptase inhibitors (NRTIS)
Emtriva)
efavirienz + tenofovir +
emtricitabine
Rescriptor® delavirdine, DLV
Sustiva® efavirenz, EFV
Viramune® nevirapine, NVP

ACTG 5142
ACTG 5142: A study that compared three anti-HIV drug combos
– NNRTI + 2 NRTIs [Sustiva (efavirenz) + 2 NRTIs]
– Protease inhibitor + 2 NRTIs [Kaletra (lopinavir/rt)+ 2 NRTIs]
– NNRTI + PI [Sustiva + Kaletra (no NRTIs)]
Results:
– Sustiva + NRTIs is two times more likely to cause fat loss
(lipoatrophy) than Kaletra + NRTIs
– Sustiva + Kaletra had lowest rate of fat loss
• 8% at 96 weeks compared to 36% in Sustiva + NRTIs arm
vs 18% in Kaletra + NRTIs arm
– Patients using Viread (tenofovir, TDF) had less fat loss
compared to other NRTIs used—Retrovir (AZT) or Zerit (d4T)
[Haubrich R, Riddler S, DiRienzo G, et al. 14th CROI, Los Angeles, 2007, Abs 38.]
[Riddler SA, Haubrich R, DiRienzo G, et al. XVI International AIDS Conference, Toronto, 2006, Abs THLB0204.]

Families of HIV drugs:
Protease Inhibitors (PIs)
Aptivus® tipranavir, TPV
Crixivan® indinavir, IDV
Invirase® saquinavir, SQV
Kaletra® lopinavir + ritonavir,
LPV/RTV
Lexiva® fosamprenavir, fos-
APV
Norvir® ritonavir, RTV
Prezista™ darunavir, DRV
Reyataz® atazanavir, ATV
Viracept® nelfinavir, NFV

Families of HIV drugs:
Entry Inhibitors
Fuzeon® enfuvirtide, ENF
Selzentry® maraviroc, MRV

Summary of factors
Factors not associated with
lipoatrophy:
• Diabetes
• Lower nadir CD4+ cell counts
• White race
A
s
s
Factors associated with
lipoatrophy:
• Specific NRTIs (Zerit and
Videx)
• Lower baseline CD4,
body mass index (BMI),
• Cholesterol treatment
[Lichtenstein KA. J Acquir Immune Defic Syndr. 2005; 39:395-400;]
[Moyle, G. et al. The Rave Study. ICAAC, 2005]

SMART Study
People experiencing fat loss ask, ―SHOULD I STOP MY PILLS?‖
The short answer is: ―NO!‖
The long answer includes information about the SMART Study:
• A huge study (5,472 people), SMART compared continuous anti-
HIV treatment against intermittent (―on and off‖) treatment to see
if side effects could be lessened and the virus still controlled or
suppressed
• The study was stopped because of more AIDS and more deaths
in the intermittent group; risk of heart disease was also greater in
this group
[Phillips A, Carr A, Neuhaus J, et al. CROI 2007 Abs 41. ]

Take-home messages
• Daily, continuous anti-HIV treatment is better for
the heart AND for controlling HIV than ―on and off‖
anti-HIV treatment
• Some anti-HIV drugs cause less fat loss than others
• It‘s better to avoid fat loss than to try to get fat back once it‘s
gone

Facial lipoatrophy grading
Progression of facial fat loss
–Grade 1: Obvious only to patient
–Grade 2: Others start to notice
–Grade 3: Everyone notices
–Grade 4: Mirrors become the enemy
[Grinspoon, Carr. N Engl J Med 2005; 352:48.]
[James J et al. Dermatol Surg 2002;11:979–986.]

Self-reported fat loss
10
20
30
40
50
60
70
0
10
20
30
40
50
60
70
Upper
Back
Abdominal
Fat
WaistChestNeckLegsButtocksArmsFaceCheeks
0
Men
Women
HIV+ HIV-
%ReportingFatLoss%ReportingFatLoss

Tools to measure fat loss
• Different amounts x-ray energy are
absorbed by fat, muscle and bone
• Exposes patient to only 20% of the
radiation that a regular chest x-ray
uses
• Very accurate; recommended at
change of HIV therapy, especially
when fat loss is reason for switch
• Covered by most insurance
DEXA (Dual-Energy X-ray
Absorptiometry)
[Levine J et al.[Levine J et al. J Appl PhysiolJ Appl Physiol 2000;88:452.]2000;88:452.]
[Kamel E. et al[Kamel E. et al Obes ResObes Res 2000;8:36.]2000;8:36.]
[Mitsiopouools[Mitsiopouools J Appl PhysiolJ Appl Physiol 1998;85:115.]1998;85:115.]

Tools to measure fat loss (2)
• Uses x-rays to look at slices of the body. Expensive, more
commonly used to measure fat gain, exposes patient to
radiation, 1 per year allowed.
Lower jaw
(mandible)
measure -
left
[Carey D et al. CROI 2007; Los Angeles. Abs #40.]
CAT scan
•Baseline mandible - left
•Baselines drawn between points of bone
•Maximum distance to skin line measured

Skin-fold test
A metal tool is used to
―pinch‖ body tissue in
several places. The
measurements are
compared to standards.
Requires a skilled
technician.
MRI (Magnetic Resonance Imaging)
uses a magnetic field to create an image of
the body showing the location and amount of
fat; very expensive
[Levine J et al.[Levine J et al. J Appl PhysiolJ Appl Physiol 2000;88:452.]2000;88:452.]
[Kamel E. et al[Kamel E. et al Obes ResObes Res 2000;8:36.]2000;8:36.]
[Mitsiopouools[Mitsiopouools J Appl PhysiolJ Appl Physiol 1998;85:115.]1998;85:115.]

Waist-to-hip ratio uses a
mathematical formula to
measure fat:
• May not hold true for
people with HIV who have
gained fat around the waist
• Gender and how much a
person is overweight has
to be brought into the
equation

Take-home messages
DEXA is the best test to get an all-around look at fat loss:
• Reliable and fairly easy to get for most people in the US
• Can measure facial fat loss
• Also measures bone density

Fat loss and stigma
Fat loss may:
• Be an unintentional signal to others of HIV-positive status
• Decrease a person‘s confidence and social involvement
• Cause a person to avoid or stop needed anti-HIV medication
because of fear of stigma
[O‘Donovan CA, et al.. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in
HIV. November 13-16, 2005, Dublin, Ireland. Abs 34. Antiviral Therapy 2005; 10:L24.]

HIV-related stigma
The general public still fears and judges people living with HIV, and
such feelings can:
• Cause negative feelings toward persons living with HIV/AIDS, their
families and friends
• Make it easy to justify treating those of different gender, sexuality,
and race badly
[Rintamaki L, Davis T, et al. AIDS Patient Care and STDs. 2006, 20(5): 359-368. doi:10.1089/apc.2006.20.359.]

Management options
1. Non-surgical options
2. Surgical options
Two main types of management options have been studied in
clinical trials:

Can’t we just take another pill?
Agents studied to try
to increase fat
Results
Rosiglitazone Minimal effect and may hurt heart by raising
cholesterol and triglycerides
Pioglitazone In one study pioglitazone raised limb fat but only
in those NOT taking Zerit (stavudine, d4T)
Pravastatin Fat gains shown but the study was small, and of
short (12W) duration
Uridine NucleoMaxx® is EXPENSIVE! Fat gains shown but
the study was small, and of short (12W) duration
Human Growth Hormone Makes fat loss worse
[Slam L, et al. 13th CROI 151LB.]
[Cavalcanti RB, et al. and Grinspoon S et al. J Infect Dis.--both Published online, ahead of print (May 2, 2007).]
[Mallon PWG et al. Antiviral Therapy 10: L5, 2005.]
[Macallan, DC, et al.. 46th ICAAC. Abs H-1897.]

Surgical options - facial restoration
• There are currently several treatments to restore the
appearance of the face
• These products are facial fillers that correct the symptoms of
lipoatrophy
• They do not correct the cause of the problem: fat cell destruction

Commonly-used options for
HIV-related facial lipoatrophy
PRODUCT TYPE/SESSIONS FDA APPROVED? COST
Sculptra (Poly-
L-lactic acid)
Non-
permanent/
several
sessions
needed
Yes Patient assistance for product
only (under $40,000/yr income:
www.needymeds.com/papforms/
sculpt1039.pdf). Labor cost avg.
$400 per session. Full price:
$1100 per session for product.
Radiesse
(Calcium
hydroxylapatite)
Non-
permanent/
several
sessions
needed
Yes Patient assistance for product
only (under $80,000 a year
w/sliding scale). Labor avg. $400
Full price: $1200 per session.
Silikon 1000
(Purified
polydimethyls-
iloxane)
Permanent/
several
sessions
needed
Off label use:
FDA approved
for intraocular
injections to
treat CMV-
related retinal
detachment
No patient assistance available.
Full price: $800 per session.
Table provided by PoWeR (Program for Wellness Restoration) and www.facialwasting.org.
Source: Comparison of Poly-L-lactic Acid and Calcium Hydroxylapatite for Treating Human
Immunodeficiency Virus-Associated Facial Lipoatrophy; Cosmetic Dermatology, May 2007, Vol 20 No. 5

Commonly used options for
HIV-related facial lipoatrophy (2)
PRODUCT TYPE/SESSIONS APPROVED? COST
PMMA-
polymethylmetha
crylate
Permanent/
1-2 sessions
needed
Not FDA
approved:
Mexico, Brazil
$1200 avg total
cost
Autologous fat
transfer: fat pulled
from one spot in the
body and injected
into the face
Non-permanent/
several sessions
needed
FDA approved $3,000 avg total
cost
Hyaluronic Acid
(Restylane,
Perlane,
Hylaform)
Permanent/
several sessions
needed
Only Restylane is
FDA approved
Approximately
$1,500 per visit
Polyalkylimide
(Bioalcamid)
Permanent/
several sessions
needed
Not FDA
approved:
Europe, Canada,
Mexico, others
$4,500 avg total
Table provided by PoWeR (Program for Wellness Restoration) and www.facialwasting.org.
Source: Comparison of Poly-L-lactic Acid and Calcium Hydroxylapatite for Treating Human
Immunodeficiency Virus-Associated Facial Lipoatrophy; Cosmetic Dermatology, May 2007, Vol 20 No. 5

Before After
• The hope is that
the results will
be visible and
safe
• There is risk
of infection
and unwanted
results with all
facial fillers

Reconstructive therapy
recommendations: DHHS 2006
Adverse effects Fat maldistribution
Causative ARVs PIs; d4T
Onset /clinical
manifestations
Onset: Gradual: months after initiation of therapy
Symptoms:
• Lipoatrophy: peripheral fat loss manifested as facial thinning,
thinning or extremities and buttocks (d4T)
• Increase in abdominal girth, breast size, and dorsocervical fat
pad (buffalo hump)
Estimated frequency High: exact frequency uncertain; increases with duration on
offending agent
Risk factors Lipoatrophy: low baseline body mass index
Prevention/Monitoring None to date
Management • Switching to other agents may slow or halt progression;
however, may not reverse effects
• Injectable poly-L-lactic acid for treatment of facial lipoatrophy
[DHHS Panel on Antiretroviral Guidelines for Adults and Adolescents 2006]

Butt-enhancer pants
• Padded shorts are designed to
– Make sitting less painful
– Fill out clothing and give a more ―normal‖ rear view

Butt pants add back
• Male and female versions available
• Cost $35-$40

What have we learned?
• It is better to avoid fat loss in the first place with careful anti-HIV
drug selection than to try to fix it after it‘s gone: The NRTI, Zerit
(stavudine, d4T)—and to a lesser extent, Retrovir (zidovudine,
AZT)—are to be avoided, if possible.
• Some anti-HIV drugs are more fat-loss friendly than others: Viread
(tenofovir), Ziagen (abacavir), Kaletra (lopinavir/ritonavir) have all
shown little—or significantly less—fat loss than the drugs they were
compared to in recent studies
• Switching Zerit or Retrovir to fat-loss friendly NRTIs can help
restore some fat, but a return to ―normal‖ isn‘t happening
• Use DEXA scan to assess for fat loss (or fat gain) early on and later
in therapy. It‘s good to have results from different time periods to
compare
• There are patient assistance programs available to help with cost of
two facial filler treatments

Tips to assist patients
• Always ask healthcare
providers to do his/her
homework (you do some
too!) before choosing
various therapies
• Be sure to continue to find
ways to obtain up-to-date
information and resources
related to fat loss, and share
the info with others

Patient–provider communication
• Taking anti-HIV therapy when and how it is supposed to be
taken is a key part of HIV treatment success
• Healthcare providers
should address all stigma-
related issues (including fat
loss) when counseling
patients before antiretroviral
treatment is started

Patient–provider communication (2)
• Counsel patients about when to start or change
anti-HIV treatments
• Listen to patients‘ concerns and assist them in finding the
anti-HIV medicines that best fit their needs
[Rintamaki L, Davis T, et al. AIDS PATIENT CARE and STDs, Volume 20, Number 5, 2006]

Resources
For more lipoatrophy and HIV–related info:
• Search term for Internet: HIV lipoatrophy 2007
• www.thebody.com
• www.aidsmeds.com
• www.thewellproject.com
• www.aids-etc.org
For more info on padded undershorts:
• www.buttforyou.com
• www.lipowear.com
For providers: Lipodystrophy Case Definition webtools
• www.ti3m.com/hiv/default_ld.htm

Resources (2)
For more info on facial fillers:
• www.facialwasting.org
• www.sculptra.com
• www.thebody.com/lipo/sculptura
• www.jromano.com

of Lipoatrophy in HIV
Legal Disclaimer
The material presented here does not necessarily reflect the views of
Visionary Health Concepts or companies that support educational
programming on www.freehivinfo.com. These materials may discuss
therapeutic products that have not been approved by the US Food and Drug
Administration and off-label uses of approved products. A qualified healthcare
professional should be consulted before using any therapeutic product
discussed. Readers should verify all information and data before treating
patients or employing any therapies described in this educational activity.
Copyright© 2007 Visionary Health Concepts

CEU Post Test and Evaluation at
www.freehivinfo.com
Thank you for participating in this program.
Click here to take the CEU Post Test and Evaluation
for this program to earn credit for your participation
or visit www.freeHIVinfo.com.
If you haven‘t already done so, don‘t forget to join Visionary Health
Concepts‘ mailing list to make sure you receive all our free
education for healthcare providers and consumers.

The What, Why and How of Lipoatrophy in HIV

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Destaque

Destaque (7)

Semelhante a The What, Why and How of Lipoatrophy in HIV

Semelhante a The What, Why and How of Lipoatrophy in HIV (20)

Mais de Asociación Lazos Pro Solidariedade

Mais de Asociación Lazos Pro Solidariedade (20)

Último

Último (20)

The What, Why and How of Lipoatrophy in HIV