In human immunodeficiency virus (HIV) infection, abdominal fat accumulation is associated with ectopic (out of place) fat accumulation in the liver. Nonalcoholic fatty liver disease (NAFLD) may progress to end-stage liver disease and liver cancer. To date, there are no approved pharmacological strategies to reduce liver fat. Takara L. Stanley of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues randomly assigned 50 antiviral-treated HIV-infected men and women with abdominal fat accumulation to receive Tesamorelin (n=28), or placebo (n=22), subcutaneously daily for 6 months.
The researchers found a modest but statistically significant decrease in liver fat with Tesamorelin. Hepatic lipid to water percentage (a measure of liver fat), decreased in the Tesamorelin group (median, -2.0 percent) compared with placebo (median, 0.9 percent). In addition, there was a significant reduction in abdominal fat: the average change was -9.9 percent with Tesamorelin vs 6.6 percent with placebo.
"The decrease in liver fat in this study suggests that strategies to reduce visceral adiposity merit further investigation in HIV-infected patients with NAFLD, a condition for which there are no approved treatments. Importantly, NAFLD is associated with visceral adiposity and other metabolic abnormalities in HIV," the authors write. AIDS is the sixth leading cause of death among people aged 25 - 44 in the United States. This is an improvement since it was the number one killer in 1995. At the end of 2010, an estimated 91,500 people in the UK were living with HIV. Of these, around 1 in 4 (22,000 in total) did not know they were infected.
The World Health Organization (WHO) estimates that around 34 million people in the world are living with HIV. The virus is particularly widespread in sub-Saharan African countries, such as South Africa, Zimbabwe and Mozambique.
AIDS is caused by HIV infection. The virus attacks the immune system leaving the individual susceptible to life-threatening infections and cancers. Common bacteria, yeast, parasites, and viruses that usually do not cause serious disease in people with healthy immune systems can turn deadly for AIDS patients. HIV is found in all the body fluids including saliva, nervous system tissue and spinal fluid, blood, semen, pre-seminal fluid, which is the liquid that comes out before ejaculation, vaginal secretions, tears and breast milk. Only blood, semen, and breast milk have been shown to transmit infection to others. The virus is transmitted by sexual contact including unprotected oral, vaginal, and anal sex and via transfusion of contaminated blood that contains HIV.
Another mode of transmission is sharing needles or injections with HIV infected individuals. A pregnant woman can transmit the virus to her unborn baby through their shared blood circulation, or a nursing mother can transmit it to her baby in her breast milk. HIV infection does not spread by casual contact, mosquitoes, touching or hugging.
Those at highest risk include injection drug users who share needles, babies born to mothers with HIV (especially if the mother had not received anti- HIV therapy during pregnancy), those engaging in unprotected vaginal or anal sex with HIV positive individuals, and those who received blood transfusions or clotting products between 1977 and 1985 (before screening for HIV became standard practice).
HIV infection may cause no symptoms for a decade or longer. At this stage carriers may transmit the infection to others unknowingly. If the infection is not detected and treated, the immune system gradually weakens and AIDS develops. Acute HIV infection takes a few weeks to months to become a non-symptomatic HIV infection. Then it becomes early symptomatic HIV infection and later it progresses to AIDS.
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