2nd International Workshop on Adverse Drug Reactions and Lipodystrophy, Toronto, Canada, 13-15 September 2000

Introduction

The Second International Workshop on Adverse Drug Reactions and Lipodystrophy was held from 13-15 September, 2000 in Toronto – a few days prior to ICAAC. Approximately half the 300 or so attendees were from industry, many involved in basic science, and although the relevance and quality of presentations varied, it was encouraging to hear presentations focussing on the mechanisms behind the symptoms of this syndrome, particularly fat and insulin resistance, lipoatrophy, mitochondrial toxicity and other changes in body composition.

Additional sessions looked at atherosclerosis and cardiovascular risk (sufficiently import to warrant new changes within the US guidelines for starting antiretroviral treatment) and the increasingly important changes in bone mineral density, osteopenia and avascular necrosis (AVN).

There were fewer reports on managing patients although switching strategies were covered in 11 poster presentations. Generally data on the effectiveness of this approach is limited by poorly defined studies and lack of consistent methodology.

The meeting showed that it is still not possible to provide an easy association of single drugs to single effects – and few of the studies were either looking for this or sufficiently powered to be able to make these links. It seems less likely that any of the currently available drugs will be able to achieve the somewhat more modest goal (compared to eradication) of turning HIV into a long-term manageable condition.

Maintaining virological control is only possible in the majority of patients by disrupting normal metabolic functions and while in the short-term (2-3 years) this is often both manageable and preferable to the effects of HIV itself, there was little confidence at this meeting that the long-term (10-20 years) use of currently available agents would be easy or even possible.

Unfortunately, most studies on lipodystrophy still fail to differentiate between symptoms of lipodystrophy and lipoatrophy and inadequately describe baseline characteristics and study results. The lengthy debate on the definition at last years meeting was not repeated. The US Forum for Collaborative Research working groups for lipodystrophy and bone and mitochondrial toxicity, particularly highlighted the need to:

study the effect of HIV drugs, and combinations, in both HIV and non-HIV infected people, including new drug development
to start these before the onset of therapy (baseline DEXA etc)
to standardise bloodsampling (fasting lipids etc) and assays (lactate, mtDNA etc)
to clarify and extend the range of tissues studied and to further develop animal models

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