Lipodystrophy and HIV

Lipodystrophy is a problem with the way the body produces, uses, and stores fat. It is also called fat redistribution. Since the widespread use of antiretroviral therapy began, the numbers of HIV-positive people with lipodystrophy has increased. Today, lipodystrophy occurs in 30% to 50% of people who are infected with HIV (human immunodeficiency virus).

Symptoms of Lipodystrophy

There are two types of lipodystrophy: fat loss and fat buildup. Men tend to lose fat. Women tend to build up fat.

Fat loss (lipoatrophy) occurs in certain areas of the body:

• Arms and legs (veins tend to show up more)
• Face (sunken cheeks, temples, or eyes)
• Buttocks

Fat buildup (lipohypertrophy or hyperadiposity) is when fat accumulates in certain areas of the body:

• Abdomen (central obesity)
• Breasts (occurs in both men and women)
• Back of neck and shoulders (sometimes called a "buffalo hump")
• Fatty growths in different parts of the body (called lipomas)

Causes of Lipodystrophy

These are possible causes of lipodystrophy:

• Antiretroviral therapy. There are conflicting ideas about this. At one time, HIV experts suspected one class of HIV medications, protease inhibitors (PIs). Later they believed that taking PIs together with nucleoside reverse transcriptase inhibitors (NRTIs) was the problem. The longer you take these medications, the greater your risk appears to be. An NRTI linked to fat loss is Zerit (stavudine, d4T).
• Decreases in viral load. Other HIV experts believe that lipodystrophy may result mainly from rapid, long-lasting decreases in viral load. This results from effective antiretroviral therapy, not from any class of medications.
• HIV. HIV itself may interfere with the way the body processes fat. More severe and lengthier HIV disease may increase your risk.

It's important to be aware that fat loss can also be due to AIDS wasting syndrome.

Other risk factors for lipodystrophy include:

• Being older or white
• Being obese or having significant changes in weight

Diagnosing Lipodystrophy

A physical exam may be all that is needed to diagnose lipodystrophy. Your doctor may measure around your arms, thighs, waist, hips, and neck. Then your doctor can compare these measurements with future measurements to note changes.

It's common to have other metabolic disorders along with lipodystrophy. These disorders may include high cholesterol or insulin resistance. Insulin resistance is a condition that can lead to diabetes. These disorders can also increase your risk for other problems such as heart disease.

For these reasons, your doctor may request lab tests to detect:

• Increased triglyceride (a blood fat) levels
• Increased LDL (bad cholesterol) levels
• Decreased HDL (good cholesterol) levels
• Elevated blood sugar level
• High blood pressure

Treating Lipodystrophy

No specific treatment exists for lipodystrophy. You may benefit from doing the following.

Making changes to your HIV medications. Do not stop taking medications without talking with your doctor. Recent studies have shown fewer links between lipodystrophy and HIV medications. However, your doctor may recommend medication changes.

Exercising and making healthy food choices. These changes may help you to build muscle and reduce fat buildup. Exercise can improve insulin sensitivity. Both aerobic exercise and resistance exercises can increase strength and cardiovascular health. Both can reduce abdominal fat. Do not attempt rapid weight loss.

Taking medications. You may need medication to treat disorders associated with lipodystrophy.

• If you have high blood sugar (hyperglycemia) and insulin resistance, your doctor may prescribe Glucophage (metformin). A serious side effect of Glucophage is lactic acidosis, a buildup of lactate in the body.
• If you have high cholesterol, your doctor may prescribe a cholesterol-lowering medication, such as Lipitor (atorvastatin).

Considering other options. The FDA has not yet approved most of these treatments for lipodystrophy:

• Hormone treatments (such as testosterone and human growth hormone)
• Cosmetic implants or injections of synthetic material to fill out sunken cheeks. Sculptra (poly-L-lactic acid) is the only product approved specifically for facial fat wasting. It increases skin thickness in the areas where it is injected.
• Surgery to remove fat deposits