Volume 10 Number 11/12 November/December 2009

Welcome to the November/December issue of HTB that includes selected reports from five conferences.

Of interest, three of these conference reports include studies looking at lipohypertrophy.

Although the side effect profile of ARVs has dramatically improved since 1996, including a better understanding of how to manage and avoid many of the symptoms of lipodystrophy, little progress has been made on fat accumulation.

No class of drugs, or individual drug, has been cleared from this association, and recent studies fail to show any correlation with plasma lipids. For example, even drugs with a relatively benign, or even favourable, lipid profile (nevirapine, atazanavir and raltegravir) have not shown differences in fat accumulation compared to standard of care control groups.

Genetics are likely to explain many interpatient differences but this has not so far resulted in sceening tests. We report differences by race and gender from a Canadian study that was presented at the Lipodystrophy Workshop, and this supports previously annectodal experience that lipohypertrophy may occur more frequently in African women.

Management options are also limited. Reductions in VAT from treatment with either rHGH or tesamorlin (neither of which are currently licensed in Europe for this indication) both return to baseline if either intervention is stopped.

A multifocus approach can be currently recommended: and diet, exercise, treatment switching and perhaps a therapeutic intervention, all being needed to attempt to shift the underlying mechanism responsible – and it is disappointing when research looks at single interventions in isolation.

Also in this issue, Richard Jefferys from TAG provides an excellent analysis of the controversial results from the RV144 Thai Vaccine Trial – a report from the 9th AIDS Vaccine Conference. Jeffrrys has provided a consistent voice of reason as the trial data was released amid a maelstrom of conflicting press and media coverage.

Other articles include, drug interaction studies presented at ICAAC from the HIV Drug Interactions group in Liverpool and an overview of paediatric studies conducted in the South concludes our reports from IAS2009. As this is the last HTB of the year we would also like to take the opportunity to thank our medical board and other advisors for their invaluable comments and feedback.