scarlet1967 wrote: "Among 518 studied participants, two-thirds were females, and the mean age of the study population was 45 years (SD=11). The mean duration of cART was 10 years (SD=4). Median CD4 count was 460 cells/mm3. The prevalence of MetS according to the Adult Treatment Panel III (2005) criteria was 37.6%...
The prevalence of lipodystrophy was 23.6%..."
https://bmjopen.bmj.com/content/bmjopen/13/12/e069637.full.pdf
The interesting parts are mean age was 45 years and mean duration on antivirals 10 years so we are not talking about aging PLWH who have been treated for decades also their treatment with antivirals has been efficient as their CD4 counts are well above the 200 cells/mm2 threshold. Yet the prevalence of metabolic syndrome was about 38 percent(higher risk for heart diseases among others)and as for lipodystrophy(a metabolic disease )about 1 of 4 patients suffered from the condition. Admittedly there are many variables which need to be considered between these studies but the general idea is the reality that HIV and some combination therapies are responsible for serious medical conditions which need to be addressed if not prevented.
Tesamorelin improves the metabolic profile of HIV patients and treat lipodystrophy so the sooner HIV patients get started on the drug the better HIV care.
Another issue with PLWH is the fact that they are at high risk of impaired cognition add to that the below:
"Our results showed that people living with HIV who had NASH with significant activity and liver fibrosis had higher odds of having cognitive impairment compared with their counterparts without these conditions,” Dr. Han says. The results “underscore the necessity for increased attention to cognition among people with HIV who are receiving long-term care,” he continues."
https://www.physiciansweekly.com/liver-disease-further-impairs-cognition-in-patients-with-hiv/
It's worth mentioning that the prevalence of NASH/liver fibrosis are much higher among PLWH than general population!
"Based on biopsy studies, prevalence of NASH and significant liver fibrosis (stage ≥F2 on histology) was 48.77% (95% CI, 34.30%-63.34%) and 23.34% (95% CI, 14.98%-32.75%), respectively. Traditional metabolic syndrome and HIV-related factors were associated with NAFLD in PLWH."
https://pubmed.ncbi.nlm.nih.gov/36642292/
It's also worth mentioning that Tesamorelin is currently investigated for impaired cognition among PLWH! As for NASH I could keep going but I think that has been covered many times before. Ignoring some of these conditions which can be prevented only will be resulting in dysfunctional and suboptimal medical care for a group of relatively uneducated patients who have to deal with not only a serious and potentially deadly disease but also the burden of added mental and physical stress because of the co- morbidities .The sale team with the support of the MSLs need to make serious efforts highlighting the issues to the patients and their caregivers and there is no room for inexcusable incompetency/failures despite all these new ongoing nformation which only should add to the therapeutic value of the drug thus easier sale for folks with " capabilities".