WELLNESS STARTS WITH AWARENESS - CD8 T cells - The Body

hormone, that he had been injecting himself with a low dose for
about seven years, and that growth hormone was why he looked
lean and youthful.
Bingo, I thought, that’s what I want. I’m a 42-year-old Polish
guy who’s put on a belly through beer and bad habits. I know what
this particular body shape should look like. But when I looked in
the mirror I saw something diff erent. I saw a huge barrel belly, an
oddly fat neck and jowls. Protruding from this mass was skinny,
scrawny arms and legs. I felt like an apple on toothpicks.
I’ve been HIV-positive for more than 20 years. I’ve spent 15 of
those years on HIV meds. Don’t get me wrong, I’m thrilled to be
alive. I’m grateful for the meds, but they left their mark on my body.
Th e physical changes from the meds were undeniable. I wasn’t just
getting older and soft er. Th e shape of my body had changed dramatically
and not in a good way. Aft er speaking with Steve, I decided
to do something about it.
I did what the pharmaceutical commercials tell me: I asked my
doctor if growth hormone was right for me. Oddly, he got a little
nervous. You don’t really have AIDS wasting, he mumbled, adding
that there are a lot of side eff ects. Instead,
he suggested a surgical procedure where
my stomach is permanently clamped off by
a band that’s implanted in the body. Th is
option seemed extreme.
Coincidentally, I heard about an experimental
drug called tesamorelin, which
supercharged your body to kick up its own
natural levels of growth hormone. Soon, I
joined a clinical trial of tesamorelin to treat
HIV-associated belly fat. Just recently, I
completed the year-long trial. Now, I have
the unique opportunity to assess how human growth hormone has
changed my life.
A hangover from the AIDS cocktail
It was around 1996 when the success of the “AIDS cocktail”
made headlines. It was a breakthrough. For the fi rst time, HIV
medicine was good enough to essentially snuff out the virus and
start to save lives. It was a welcomed change of course for a beleaguered
patient community. So it almost seemed inconsequential in
the very beginning when anecdotes of strange body-shape changes
fi rst began to emerge as a side eff ect of the medicine.
Th e AIDS cocktail got its name because it combined three different
classes of HIV drugs.
One class is the protease inhibitors, of which indinavir is a
member. Indinavir is the generic name of the drug and Crixivan is
the brand name. Another class is the nucleoside analogs, of which
zidovudine and stavudine are members. Stavudine’s brand name is
Zerit. Zidovudine’s brand name is Retrovir, but it’s better known
as AZT. It’s also one ingredient in various combination pills by the
names Combivir, Epzicom, and Trizivir.
As body-shape side eff ects emerged among patients taking the
cocktail, the changes sometimes got informally named as AZT butt
or Crix belly. It seemed that the nucleoside analogs were associated
PA • September / October 2008 • tpan.com • positivelyaware.com
Positively Aware
with fat loss in the buttocks, legs, arms, and cheeks. On the other
hand, the protease inhibitors were associated with fat gain in the
stomach, jowls, and neck. Another distressing condition was a disfi
guring accumulation of fat at the base of the neck called “buff alo
hump.”
Over time, the anecdotes could not be ignored. As researchers
examined the issue more closely, they also found unusually high
levels of cholesterol and triglycerides in the blood of patients taking
protease inhibitors. Th e range of conditions baffl ed doctors, but one
thing was clear: the common denominator was fat.
“Fat loss is clearly associated with stavudine and to a lesser
extent, zidovudine,” said Valerianna Amorosa, M.D. She is chief of
Infectious Diseases at the Philadelphia Veterans Hospital in Pennsylvania.
Her clinical practice and research focuses on conditions
related to HIV, hepatitis C, and obesity. As for the cause of buff alo
hump, she said the jury is still out. “We thought it was the protease
inhibitors, but I don’t think it’s that simple any more.”
Th ese days, the trend is to distinguish between weight gain
and weight loss as separate and distinct conditions. Weight loss in
When Steve turned the corner
and I saw him, once again I was
struck by his lean and youthful
appearance.
the butt, legs, arms, and cheeks is called lipoatrophy. Weight gain
around the belly is called excess visceral adipose tissue, which is
abbreviated as VAT. I prefer to use the lowercase vat because it’s
similar to fat, but still diff erent. Too much vat gives your body an
apple shape, with fat growing between internal organs. Gardenvariety
fat tends to distribute itself more evenly and stays just below
the skin where it’s less harmful.
Sometimes, it’s hard to tell the diff erence between fat and vat,
notes Amorosa. Th e commonly used body mass index, also called
BMI, is not a great indicator of the risks associated with being overweight.
Vat is linked to high blood pressure, diabetes, high cholesterol,
and high triglycerides. Th e diff erence between vat and fat is
where the fat lives on the person. “In somebody who has a BMI of
26, but who doesn’t have a big belly, who has a relatively fl at belly,
and has some weight in the trunk or in the bottom, I don’t worry
as much about them.”
High levels of cholesterol and triglycerides or glucose problems
are collectively referred to as metabolic syndrome. A surprising
study in 2007 found the prevalence of metabolic syndrome among
people with HIV is not any higher than that of the general population.
Metabolic syndrome, it seems, has less to do with HIV medicine
and more to do with beer and bad habits.
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