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The changes in metabolic parameters and body composition among antiretroviral-naive patients randomized to 3 antiretroviral therapy (ART) strategies are evaluated. The long-term follow-up has shown similar changes in total and regional fat, with no differences by ART strategy, but the differential effects on lipid metabolism by strategy and overall increases in insulin and insulin resistance with all 3 strategies requires close monitoring of patients on ART.

In a substudy of an ongoing multicenter randomized trial, comparisons of body composition and metabolic changes among antiretroviral-naive patients randomly assigned to didanosine and stavudine- (ddlI + d4T) vs. abacavir and lamivudine-(ABC + 3TC) containing regimens were assessed. The metabolic and body composition changes varied according to whether subjects received ddI + d4T or ABC + 3TC.

Human immunodeficiency virus (HIV)-lipodystrophy syndrome (HLS) is characterized by hypertriglyceridemia, low high-density lipoprotein-cholesterol, lipoatrophy, and central adiposity. We investigated fasting lipid metabolism in six men with HLS and six non-HIV-infected controls. Compared with controls, HLS patients had lower fat mass (15.9 [+ or -] 1.3 vs. 22.3 [+ or -] 1.7 kg, P < 0.05) but higher plasma glycerol rate of appearance ([R.sub.a]), an index of total lipolysis (964.71 [+ or -] 103.33 vs. 611.08 [+ or -] 63.38 [micro] mol * kg [fat.sup.-l] * [h.sup.-1], P < 0.05), [R.sub.a] palmitate, an index of net lipolysis (731.49 [+ or -] 72.36 vs. 419.72 [+ or -] 33.78 [micro] mol * kg [fat.sup.-1] * [h.sup.-1], P < 0.01), [R.sub.a] free fatty acids (2,094.74 [+ or -] 182.18 vs. 1,470.87 [+ or -] 202.80 [micro] mol * kg [fat.sup.-1] * [h.sup.-1], P < 0.05), and rates of intra-adipocyte (799.40 [+ or -] 157.69 vs. 362.36 [+ or -] 74.87 [micro] mol * kg [fat.sup.-1]'[h.sup.-1], P < 0.01) and intrahepatic fatty acid reesterification (1,352.08 [+ or -] 123.90 vs. 955.56 [+ or -] 124.09 [micro] mol * kg [fat.sup.-1] * [h.sup.-1], P < 0.05). Resting energy expenditure was increased in HLS patients (30.51 [+ or -] 2.53 vs. 25.34 [+ or -] 1.04 kcal.kg lean body [mass.sup.-1] * [day.sup.-1], P < 0.05), associated with increased non-plasma-derived fatty acid oxidation (139.04 [+ or -] 24.17 vs. 47.87 [+ or -] 18.81 [micro] mol * kg lean body [mass.sup.-l].[min.sup.-1], P < 0.02). The lipoatrophy observed in HIV lipodystrophy is associated with accelerated lipolysis. Increased hepatic reesterification promotes the hypertriglyceridemia observed in this syndrome. lipolysis; hypertriglyceridemia; very low density lipoprotein; high-density lipoprotein-cholesterol

Background: Lack of access to information and education makes women more susceptible to acquire HIV/AIDS. Self-help groups (SHGs) are seen as instruments for empowering women in the community. Realizing this, it was hypothesized that if the strategy to train SHG women brings significant improvement in the knowledge of study population about HIV/AIDS; then this strategy may be a financially sustainable and practicable method in rural India. Objective: Empower and engage the SHG women against HIV/AIDS by creating awareness and sustaining interest through lesson plans in the IEC material. Methods: This was a 'Multi-centric Action Research Demonstration Study'. As an intervention, series of workshops were conducted with the help of pre-developed IEC material. 400 households (200 from each intervention and control sites) of SHG women were interviewed for baseline and end line each. Results: The planned intervention could make significant changes in level of awareness of the respondents about HIV/AIDS in terms of mode of spread, prevention and control measures and places to get tested for HIV/AIDS. This was also found effective to reduce the misconceptions regarding transmission of HIV/AIDS in the study area, thus in turn reducing the stigma attached with the disease. Conclusion: The awareness level about HIV/AIDS in rural areas among SHG women was very low and there is an urgent need and scope for development and implementation of effective interventions strategy to train local community worker which in turn can bring improvement in the knowledge of community by providing the information in culturally acceptable manner. [ABSTRACT FROM AUTHOR]

Objectives: Dyslipidemia associated with antiretroviral therapy is a common clinical problem among HIV-infected patients. Considering that the challenge of adherence to drugs (both antiretroviral and lipid lowering) may be substantial in routine HIV care, our objective was to evaluate the lipid-lowering effects of statins and fibrates in the management of HIV dyslipidemias in clinical practice setting., Methods: Retrospective review of 103 ethnically diverse dyslipidemic HIV patients on antiretroviral therapy treated with lipid-lowering drugs (using National Cholesterol Education and Prevention II [NCEP II] guidelines) who were followed for a median of 70 weeks., Results: An overall mean reduction of 16% in total cholesterol, 20% non-HDL cholesterol, and 18% in triglycerides was noted. There were no significant changes in HDL levels. On evaluation of the different drug classes, the mean (median) change in total cholesterol, were -9 (-7)% with fibrates, -11 (-14)% with statins and -23 (-22)% for dual therapy with fibrates and statins. The triglycerides decreased by -11 (-40)% in those treated with fibrates; -1 (-21)% in those with statins alone, and -32 (-42)% in those with dual therapy. Overall less than a fifth of patients reached the defined NCEP target goal reduction. On logistic regression analysis, only stopping protease inhibitors/ritonavir was independently associated with significant cholesterol reduction (OR: 10.14; 95% CI: 2.1-48.9; p < 0.005)., Conclusion: In a primary care setting, the use of statins and/or fibrates may add to the complexity of HIV care, with only modest lipid lowering effects.