I know we may not have the answer to this question yet, but I thought I'd ask it anyway. I'm developing lipoatrophy on the face and the extremities after being on HAART for a little over a year. My VL is undetectable, CD4 count is normal and my lipid/blood glucose levels are also normal. My question is, should I try to slow down my metabolism by exercising to less than 2x a week? I used to do aerobic exercise and some anaerobic exercises 3-4x a week. I'm also taking L-carnitine and coenzyme Q10 to support my mitochondrial functions, but it seems like I'm hastening the lipoatrophy if I exercise more. Any thoughts about this? Thanks a lot for your time.

You are right that the answer is not in yet. But there are several things to consider before cutting down on exercise.

First, aerobic exercise can help to regulate lipid metabolism and insulin sensitivity. Disease, medications, and gain or loss in weight (especially gain of visceral fat or loss in subcutaneous fat) can contribute to abnormalities in insulin sensitivity and lipid metabolism. While there is more to the picture, it may be worth simply balancing your exercise program to make sure it includes reasonable aerobic and strength-training exercise.

Even when more answers are in, it is unlikely that the picture will be simple enough to give a blanket "yes" or "no" on this question. Keeping an even keel on your activity may be the most reasonable course at this time.