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Lipodystrophy syndrome and HIV

Lipodystrophy syndrome is a relatively common side effect of antiretroviral treatment for HIV where fat accumulates or is lost, changing a person's body shape.

Although the fat isn't normally a significant additional threat to health, the rolls of fat can cause worry.

Symptoms of lipodystrophy

There are two types of lipodystrophy: fat loss and fat build-up. 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 build-up (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 some of the 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). They subsequently 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.
  • 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 experiencing significant changes in weight

Diagnosing lipodystrophy

A physical examination 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 of other problems such as heart disease.

For these reasons your doctor may carry out tests to detect:

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 medication without talking to 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 build-up. 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 (hyperglycaemia) and insulin resistance, your doctor may prescribe metformin.
    • If you have high cholesterol, your doctor may prescribe a cholesterol-lowering medication such as a statin.

Considering other options.

  • Hormone treatments (such as testosterone and human growth hormone)
  • Cosmetic implants or injections of synthetic material to fill out sunken cheeks.
  • Surgery to remove fat deposits
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WebMD Medical Reference

Medically Reviewed by Dr Rob Hicks on April 25, 2016

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