Abdominal Fat Accumulation in HIV: Interview with Dr Grinspoon

Nelson Vergel from PowerUSA.org interviews Dr Steven Grinspoon from Harvard Medical School about what we know about HIV lipodystrophy associated fat accumulation. Dr Grinspoon covers potential causes and treatments. For more information please refer to the closing image at the end of the video.

1. Please give our audience background information on what HIV lipodystrophy is.
2. What causes HIV lipodystrophy? How is HIV lipodystrophy different than other lipodystrophies?
3. What types of fat tissue does the body have? What are their metabolic functions, if any?
4. Why is visceral fat and dorsocervical accumulation not just a cosmetic issue?
5. Talking specifically about visceral fat (VAT), have we learned about what makes someone more or less prone to having increased VAT before and after starting antiretrovirals? Is increased VAT driven by HIV as much as ART? Inflammation?
6. Are some antiretrovirals “better” than others when it comes to avoiding excessive VAT increase? Can switching HIV regimens improve VAT?
7. What kind of hormonal, lipids and glucose issues have you seen in your research with HIV+ patients experiencing increased VAT?
8. What is growth hormone pulsatile release and how does it differ in HIV lipodystrophy patients?
9. Are there any ways to predict who may have more increased VAT when starting HIV ARVs?
10. VAT then and now- Is increased VAT as common now as it was back in the 90’s and early 2000’s? If not, why? is current lipodystrophy being hidden by the aging of the HIV population? Is our perception of a decrease in prevalence being affected by the increase of fat tissue due to aging? Does current day LD look different and how?
11. What treatments are approved to manage adipose tissue accumulation in HIV? How effective is it?
12. How can we predict if someone will be a good responder to the therapy? When someone responds what should they expect? Does something happen metabolically before the response happens?
13. Can exercise and diet work in synergy with the adipose tissue treatment? How about any synergy with Metformin?
14. How does liver fat affect someone’s health? Do we experience more liver fat in HIV lipodystrophy?
15. Can you tell us how VAT can affect carotid intima thickness, coronary calcium, hypertension, neurocognitive, and mortality?
16. Follow up, will a reduction in VAT improve these? What about SAT?
17. Why has leptin not been studied further?
18. Your team recently published a puzzling study on DICER deficiency in HIV lipodystrophy patients. Can you elaborate on your findings and what they may mean clinically?
19. Why does it seem that a lot of the HIV lipodystrophy research interest has decreased in the last few years? What can patient advocates do to advance more research?


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