HIV Nutrition News Update - Iss. 3, No. 104, Oct 17, 2003

HIV Nutrition News Update - Iss. 3, No. 104, Oct 17, 2003

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HIV/AIDS Resources
* The Winter 2003 edition of "Positively Aware" (nutrition issue) is
available in Spanish
<http://www.tpan.com/publications/positively_aware_en_espanol/pa_espanol.html>.

* The Henry J. Kaiser Family Foundation and The Jacobs Institute of
Women’s Health offer "Women’s Health Data Book: A Profile of Women’s
Health in the United States"<http://www.kff.org/content/2001/6004>.
Individual copies of this publication (#6004) may be obtained by calling
the Foundation's publication request line at 800/656-4533. Multiple
copies may be obtained from the Jacobs Institute by calling
202/863-4990.
* "Health Care and HIV: Nutritional Guide for Providers and Clients" is
available online at <http://www.aids-etc.org>.

Post-Publication News - Leptin And Adiponectin

Recently published information on leptin and lipodystrophy adds to that
found in the Update Central column published in Issue 41 of the HIV
Nutrition Update <http://www.hivresources.com/Selenium.PDF>.
Increasingly more sources are noting that leptin may play a role in
HIV-related lipodystrophy.

Murine studies suggest that leptin replacement therapy may help to
reduce metabolic abnormalities associated with the treatment of HIV by
highly active antiretroviral therapy (HAART). (1) Murine studies of
leptin treatment also suggest that insulin up-regulates and leptin
down-regulates adipocyte fatty acid uptake, leading to alterations in
fatty acid partitioning that affect fat cells. (2)

Lipodystrophy patients have significantly reduced plasma leptin levels
and leptin replacement therapy may reduce hepatic fat mass and improve
insulin sensitivity. (3) Preliminary studies by Nagy and colleagues
working in Boston report that after controlling for total and regional
body fat, significantly reduced leptin levels in HIV-positive patients
with lipoatrophy were independently associated with insulin resistance.
(4) Sutinen and others report the severity of insulin resistance in
HAART patients correlates with fat accumulation in the liver. (3)
Investigators note leptin-induced improvements in insulin sensitivity
accompanied by reductions in intrahepatic and intramyocellular lipid
accumulation. (5)

We know that leptin plays a role in energy homeostasis and now
investigators are attempting to determine if it influences bone
development and remodeling. Preliminary data from two women showed that
subcutaneous leptin replacement therapy had no effect on bone in
hypoleptinemic patients with generalized lipodystrophy. (6)

Adiponectin is a fat cell-secreted protein that acts to increase insulin
sensitivity. As in a murine model of lipodystrophy, patients on HAART
with fat redistribution may have decreased levels of adiponectin. (7) In
some HIV-positive patients treated with HAART, adiponectin is directly
correlated with high-density lipoprotein cholesterol and extremity fat
and inversely correlated with abdominal visceral fat mass, serum
triglycerides, and insulin resistance. Addy and others note the use of
non-nucleoside reverse transcriptase inhibitors may worsen insulin
resistance by decreasing adiponectin levels. These investigators report
that adiponectin treatment improves metabolic syndrome in adiponectin
deficient mice. Although there may be a link between adiponectin,
central obesity and insulin resistance there is no association between
serum adiponectin and leptin. (8) Gavrila and colleagues report that
neither fasting for two days, which results in a low leptin state, nor
leptin administration alters serum adiponectin levels in women without a
known history of diabetes.

References
1. Riddle TM, et al. Leptin Replacement Therapy but not Dietary
Polyunsaturated Fatty Acid Alleviates HIV Protease Inhibitor-Induced
Dyslipidemia and Lipodystrophy In Mice. JAIDS 2003;33(5):564-70.
2. Fan X, et al. Leptin and Insulin Modulate Nutrient Partitioning and
Weight Loss in ob/ob Mice through Regulation of Long-Chain Fatty Acid
Uptake by Adipocytes. J Nutr 2003;133:2707-2715.
3. Sutinen J, et al. Increased Fat Accumulation in the Liver in
HIV-Infected Patients with Antiretroviral Therapy-Associated
Lipodystrophy. AIDS 2002;16(16):2183-93.
4. Nagy GS, et al. Human Immunodeficiency Virus Type 1 Related
Lipoatrophy and Lipohypertrophy Are Associated with Serum Concentrations
of Leptin. CID 2003;36(6):795-802.
5. Simha V, et al. Effect of Leptin Replacement on Intrahepatic and
Intramyocellular Lipid Content in Patients With Generalized
Lipodystrophy. Diabetes Care 2003;26(1):30-35.
6. Simha V, et al. Effect of Subcutaneous Leptin Replacement Therapy on
Bone Metabolism in Patients With Generalized Lipodystrophy. J Clin
Endocrinol Metab 2002;87(11):4942-5.
7. Addy CL, et al. Hypoadiponectinemia is Associated With Insulin
Resistance, Hypertriglyceridemia, and Fat Redistribution in Human
Immunodeficiency Virus-Infected Patients Treated With Highly Active
Antiretroviral Therapy. J Clin Endocrinol Metab 2003;88(2):627-36.
8. Gavrila A, et al. Serum Adiponectin Levels Are Inversely Associated
With Overall and Central Fat Distribution but Are Not Directly Regulated
by Acute Fasting or Leptin Administration in Humans: Cross-Sectional and
Interventional Studies. J Clin Endocrinol Metab 2003;88(10):4823-31.

Editors Note: Although we focus on nutrition and HIV related issues the
fight for affordable medications appears worth mentioning as it affects
everyone. If you find the cost of prescribed medications unjustly high
please view the Fight For Affordable Drugs Web Site at
<http://www.affordabledrugs.il.gov/PetitionAction2.cfm>.

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Information in this news update should not be construed as an
endorsement of any kind. Comments are offered for general guidance only.
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of HIV ReSources Inc., the editors, authors, or the publisher. Discuss
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 --
Sharon Ann Meyer, AS, AA, DTR
President, HIV ReSources, Inc.
Secretary, ADA HIV/AIDS DPG #29
"Improving the quality of life for HIV-challenged
individuals through effective nutritional services."
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