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Changes in body fat in people with HIV

Picture of Tina Gutiérrez
Tina Gutiérrez

The abnormal distribution of body fat is one of the side effects that are visible when someone is on antiretroviral treatment. Although the newer drugs have been shown to cause less of this effect, it is also true that so far it is not possible to predict who will develop this condition and who will not.

Although it is not its precise medical meaning, in the field of HIV the term lipodystrophy has been used to describe both the loss of fat where it should be (for example, cheeks or buttocks) and the accumulation of it in an exaggerated way (as in the back of the neck, abdomen, or breasts in men and women).

This abnormal distribution has been linked to certain types of antiretroviral drugs, and was sometimes so bothersome that people chose to stop treatment. Unfortunately, there is no scientific evidence that stopping the medication helps reduce or reverse lipodystrophy. On the other hand, it is proven that stopping treatment leads to serious damage to the immune system of people with HIV.

What causes lipodystrophy?

Even today, all the factors that intervene in the appearance of lipodystrophy are unknown, explains the website of the Working Group on HIV Treatments (gTt-HIV). However, some antiretroviral drugs have been associated with the development of this condition.

For example, fat loss (also called lipoatrophy) is associated with a class of HIV drugs called nucleoside analogs, which include stavudine and zidovudine.

In the case of abnormal fat gain, this has been related to antiretroviral of the protease inhibitor type.

But there is also a concern about fat that has nothing to do with physical appearance, and this refers to the increase in substances such as cholesterol and triglycerides, which may be due to antiretroviral treatment in general.

How do I know if I have it?

The easiest way to detect changes in fat accumulation is by observing. Although not all cases are the same, the most frequent areas where fat is lost are:

  • Cheeks (look sunken)
  • Arms
  • Legs

On the contrary, the areas of the body where adipose tissue can accumulate in an abnormal way are:

  • The back of the neck (a kind of hump or hump that can be very large and cause pain)
  • The abdomen
  • The pubis
  • The chest (in women the accumulation of fat can be so great that the breasts hurt)

None of these changes in body fat put your life at risk, as reported by the Live positive guide, edited by the Argentine Ministry of Health. What can significantly affect your health is stopping treatment due to the discomfort of lipodystrophy.

On the other hand, in the case of blood fats, such as cholesterol and triglycerides, these can only be measured with laboratory tests, so it is important that your medical team monitor these indicators from time to time in your consultations.

How can I improve lipoatrophy?

As we mentioned, it is not proven that stopping certain types of medications or even antiretroviral treatment altogether (which is absolutely not recommended) will help reverse lipoatrophy.

However, there are options to improve the appearance of your body if it has become a problem for you, either physically or psychologically.

Changes in fat can be detected early by certain measurement techniques, which may allow the process to be stopped when it is just starting (your doctor will know how to deal with this).

On the other hand, both the loss of facial fat and the accumulation of fatty tissue in other parts of the body can be repaired. The first can be treated with injection of your own fat or synthetic material to fill in the gaps in the face. The second is reduced by liposuction, which is usually successful in most problem areas of the body.

Go to your clinic

The problem of lipodystrophy has a solution and it is important that you consult your medical team to find the best strategy. Meanwhile, keep sticking to your antiretroviral treatment, as it is the tool that has saved millions of lives around the world and will keep you in the best health conditions for as long as possible.

Remember that if you haven’t started your antiretroviral treatment yet or if you suspended it and want to resume it, at AHF Panama we can help you. Come to our offices or write to us by Whatsapp and find out about our services.