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Heart Disease a New Concern for People with AIDS

Doctors detect dangerously high cholesterol levels connected to AIDS drugs

SUNDAY, Feb. 24, 2002 (HealthDayNews) -- When AIDS experts gather in Seattle today for an annual conference, an unusual topic will be on their lips -- heart disease.

Just a few years ago, AIDS doctors would have hardly discussed the risk of heart attacks, which typically strike older people. Many people with AIDS simply never lived that long.

Now AIDS drugs are extending life spans. At the same time, however, they appear to be raising cholesterol to shockingly high levels.

"We're having to go back to learning about cardiovascular medicine, which is not something we had to worry about before," says Dr. Howard Grossman, who treats people with AIDS in New York City.

As many as half those taking drugs known as the "AIDS cocktail" may need cholesterol-lowering drugs, adds Dr. Princy Kumar, director of the division of infectious diseases at Georgetown University.

The annual Conference on Retroviruses and Opportunistic Infections is set to run through Feb. 28. Several doctors spoke to reporters last week to discuss topics that are expected to come up.

For reasons that aren't completely understood, the AIDS drugs seem to affect cholesterol levels in the blood, the experts say. The subsequent problems "are probably the greatest challenge we have now in treating patients," Grossman says.

Related problems may be leading to so-called "fat redistribution" among long-time AIDS patients. Fat may vanish from the face, while reappearing elsewhere in a "buffalo hump" on the back or around the neck.

"Their faces are sunken in and wasted, and their bodies change to really horrible degrees," Grossman says.

At a recent conference attended by AIDS patients, Grossman saw many people who suffered from fat redistribution problems. "It was devastating to see that degree of deformity that people have. What it does is keep them from taking their medications," he says. "It's having a big effect on adherence."

The AIDS virus can mutate to evade drugs, especially if patients don't take their medication on a regular schedule. Drug resistance has become a major threat to the success of AIDS treatments, especially in patients who become resistant to several medications.

But the other big problem may be a higher risk of cardiovascular disease among people on the AIDS drugs. Ideal levels of "bad cholesterol" are less than 200; some AIDS patients have much higher levels, as high as 1,000.

"They go to the gym, they take care of themselves, and their cholesterol is going up to 300, 400, or 500," Grossman says. "It's not your mother's lipid-lowering situation."

Because of dangerous drug interactions, doctors can't turn to all medications that lower cholesterol, Grossman says.

That means in some cases, Grossman delays the full range of drug treatments available to combat AIDS, or avoids drugs that appear to have a higher risk of raising cholesterol levels.

"All of us would love to treat HIV the minute it's diagnosed," he says. "The fact that we're pulling back from early treatment has more to do with the side effects than it does with any desire to not treat early."

While many people with AIDS have dangerously high cholesterol levels, they don't appear to be suffering from a high rate of heart attacks, says Dr. Michael Horberg, medical director of HIV services for the Kaiser Permanente Health Plan in Santa Clara, Calif.

Those with high cholesterol levels may simply be too young to have heart attacks, he says. "There may be a lag time."

Or, he says, their high cholesterol rates may not translate into clogged arteries. "What seems logical isn't necessarily the case," he says.

What to Do: This Gay Men's Health Crisis fact sheet has more about protease inhibitors, the so-called "AIDS cocktail." Learn more about drug resistance and AIDS from AIDSmeds.com, which is supported by drug companies. Find out the basics of AIDS treatment at The Body.

SOURCES: Interviews with Howard Grossman, M.D., physician in private practice, New York City; Princy N. Kumar, M.D., director, Division of Infectious Diseases, and assistant professor of medicine, Georgetown University, Washington, D.C.; Michael Horberg, M.D., medical director, HIV services, and chairman, Northern California Pharmacy and Therapeutics Committee, Kaiser Permanente Health Plan, Santa Clara, Calif.
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