Good evening

Im 23 years old and I have HIV (type one) for 3 years. About a year and a half ago Ive started to take Combivir and Stokrin because my virus level was about 200.000 copies and my CD4 rounding 200, after four months the virus level was less than 40 copies (as it is know) and since then my CD4 have been growing, two months ago I had around 700 copies of CD4. All my life I have a belly and I dont feel comfortable with that. One last March Ive entered for a gymnasium and Ive started to loose some weight, but unfortunately the belly is still here! I have 176 centimetres (5.77 feet) and 72 Kilograms (159 pounds) and my percentage of fat is around 19%. My question is Ive been told about L-Carnitine by non positives HIVs, apparently is a compose that burns our fat while we are working out, Ive heard to about other composes similar to L-Carnitine but I dont know if I should use it or not, and which one! Ive heard about mesotherapy too but I dont know if it works or the inject product will or not interact with my anti-retroviral pills. Could you help me?

Anthony

Hi Anthony,

Thank you for your post.

On this site we frequently discuss issues of drug resistance and how this can limit the utility of antiretroviral therapy. The other major factor that can make treatment success difficult is drug toxicity. The many potential toxicities of therapy is beyond the scope of what we can discuss on this site, but certainly one that is most disturbing to patients relates to physical changes such as fat loss and fat accumulation syndromes. Unfortunately we are still learning about many of these things which make it difficult for providers to counsel and guide our patients.

The fat loss syndromes, sunken cheeks and prominent veins on the arms and legs appear to be clearly related to many factors including antiretroviral therapy. The link is strongest between the use of select nucleoside reverse transcriptase inhibitors such as stavudine and fat loss. In contrast, the relationship between HIV therapy, yet alone specific types of therapy and fat accumulation in the belly is less clear. In fact, it is difficult to find good data connecting specific types of therapy or changes in therapy with either increases or decreases in central abdominal fat.

At this time the best strategy one can use for the problem you describe is diet and exercise. For what it is worth there is even some data showing that this will selectively reduce central fat. That said, it is not perfect or a 100% effective. Other studies have suggested that in people with insulin resistance may benefit from select insulin sensitizing drugs. Similarly, there are studies suggesting that some with high lipids will benefit from lipid lowering agents (reducing central fat). Data with these types of drugs are conflicting and it is important to discuss this with your provider because they all have unique side effects. The best data for reducing fat with a specific therapy is probably with recombinant human growth hormone although this drug is not yet approved for this indication, is expensive and has specific side effects as well. I am not aware of good data with any of the other therapies you have described. Nor am I aware of information regarding interactions between these therapies and antiretrovirals. This is not to say they would not work, just that to the best of my knowledge data is limited.

Based upon all of this I believe that the only strategy I can strongly endorse is diet and exercise. All others need to be considered investigational and should not be undertaken without a complete discussion with your provider as to the potential risks and benefits.

Best, Eric