The Body Covers: The 3rd International Conference on Nutrition and HIV Infection
April 22-25, 1999
The third international conference on nutrition and HIV infection began on Thursday, April 22, 1999 in Cannes on the French Riviera. Six hundred delegates from around the world gathered to discuss the ongoing issues related to nutrition and metabolic disorders associated with HIV infection. The 4 years since the first of these conferences have witnessed a dramatic change in the face of HIV infection: death rates are down, complications are less severe and less frequent, and long-term control of HIV seems possible if not likely. In 1995 the major discussion at the conference was the evaluation of AIDS-wasting syndrome, and in 1997 the major theme seemed to be that wasting was treatable, preventable or even disappearing. Now in 1999 there is a new awareness of the metabolic complications of HAART and their relationship to HIV infection itself. Much of this area remains unexplained, controversial and confusing. Indeed we seem to be spending a disproportionate amount of time discussing just what to call these complications ... lipodystrophy, fat redistribution syndrome (my preference), lipoatrophy, etc. But whatever we get around to calling this syndrome it is a major complicating factor of HIV infection; a complicating factor that could have substantial public health implications if it leads to further complications or nonadherence to therapy. The major components of the fat redistribution syndrome (FRS) have been described and include both fat accumulation (such as truncal obesity, breast enlargement, buffalo hump) and fat depletion (face, extremities, buttocks) as well as hyperlipidemia and insulin resistance.
We all return from Cannes with an increased appreciation of metabolic disorders related to HIV infection and its treatment. The evolution of HIV infection and its treatment has been especially dynamic since the introduction of the protease inhibitors in late 1995. Problems not even anticipated then now dominate the subject; future problems not currently appreciated cannot be anticipated. Though treatment of viral replication remains paramount and central to the control of HIV infection, this treatment is much more complicated than previously thought. The role of fat redistribution syndrome in nonadherence, on selection of initial treatment regimens, and on the deferral of treatment has been barely explored. What we will be discussing in 2001 at the next HIV/nutrition conference cannot be imagined now. Malnutrition is a major factor in disease progression and quality of life in the developing world where most people with HIV infection live.
DISCLAIMER: The details discussed in these summaries are based on my notes and the program abstracts from the conference. Accuracy cannot be guaranteed, as I could not verify each and every detail after the presentations.
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