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Response from Ms. Fields-Gardner
First, get some quantitative answers by asking for a referral to a dietitian who can estimate what you need and compare it to what you really eat. Make sure that you accurately report the types and amounts of food that you consume.
That being said, if you are eating more than your estimated needs, you might be malabsorbing what you eat. Malabsorption is quite common in HIV infection, is sometimes is pretty low grade, and you may only notice it after weight has been lost. The fact that you are hungry suggests that if you are malabsorbing your body may not have fully adapted to starvation at this point. So, take care of this right away to keep that from happening!
If you are malabsorbing (or if that is suspected), you can start by doing a couple of things: ask your dietitian to outline a "low residue" diet for you that is more easily digested and ask about the use of prescription strength digestive and/or pancreatic enzymes.
As for the fat loss, that could be simple weight loss or it could be lipoatrophy. For simple fat loss, returning your weight to your goal should work pretty well (keep an eye on it, though). If it is lipoatrophy, there are complicating problems that may require more evaluation of your risk factors (which may include age, smoking, drinking, medications, and hormonal alterations, to name a few) to see what course of action is best.
While you are determining the best course of action, try doing some mild weight lifting to keep in shape. Once you get things in control you can look to going back to a routine that includes more aerobic exercise. Good luck on this!
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