Lipodystrophy, Body Changes and HIV/AIDS

Table of Contents

• What Is Lipodystrophy?
• Body Shape Changes
• Metabolic Complications
• What Causes Lipodystrophy?
• Can Lipodystrophy Be Treated?
• Caring for Yourself

What Is Lipodystrophy?

Lipodystrophy means abnormal fat changes. It is used to describe a number of changes in body fat that are experienced by many people living with HIV (HIV+). Lipodystrophy can also include changes in fat and sugar levels in the blood of people living with HIV. Although there is no official definition of lipodystrophy in HIV, it is generally broken down into two categories:

• Body shape changes -- Includes fat loss (lipoatrophy) and fat gain (lipohypertrophy) or movement of fat from one area to another (redistribution) in particular areas of the body
• Metabolic complications -- Includes increases in fats and sugars in the blood

People living with HIV can experience both body shape changes and metabolic complications. This is sometimes called lipodystrophy syndrome.

Body Shape Changes

Changes in the shape of your body can be caused by fat loss, fat build up, or fat redistribution.

Fat loss may happen in the:

• Arms and legs (fat loss may cause veins to appear larger in the arms and legs)
• Buttocks
• Face (sunken cheeks)

Fat build up may happen in the:

• Stomach
• Breasts
• Back of the neck ("buffalo hump")
• Round lumps of fat may appear under the skin (lipomas)

Some studies show that lipodystrophy affects men and women differently. Women are more likely to see fat gain in their breasts and stomachs while men are more likely to see fat loss in their legs, arms, buttocks, or faces. However, many men and women suffer from both symptoms. It is not clear why there might be differences based on sex. It may have something to do with hormones or with how men and women burn fat differently.

Lipodystrophy can dramatically change your appearance. These changes can leave some people with feelings of poor self-image and low self-esteem. Some people may want to stop taking their HIV drugs. Others may put off HIV treatment due to fear of experiencing lipodystrophy symptoms. If you are feeling this way, it is important to talk to your health care provider so that you take the necessary steps to improve your health. It is also important to know that many newer HIV drugs are less likely to cause lipodystrophy. If you are taking HIV drugs that do cause lipodystrophy, you and your provider can consider switching to HIV drugs that may reduce these symptoms.

Metabolic Complications

Changes in fat (lipids) and sugar (glucose) in your blood are called metabolic complications and include:

• Increased lipids in your blood such as cholesterol and triglycerides (hyperlipidemia)
• Increased glucose levels (hyperglycemia)
• Insulin resistance or diabetes
• Increased lactic acid in your blood

Metabolic changes cannot be seen with the naked eye; they can only be confirmed through blood tests. Without treatment, they can cause serious long-term health problems.

• Increased levels of cholesterol and triglycerides can put you at a higher risk of developing heart disease or having a heart attack or stroke
• Increased glucose and insulin levels greatly increase the chance of developing diabetes, a disease that can cause vision and kidney problems and may be life threatening
• Increased lactic acid can lead to a rare but dangerous condition called lactic acidosis. Symptoms include nausea, vomiting, or stomach pain; feeling very weak and tired; and shortness of breath.

It is important that you and your health care provider make sure you get regular lab tests to check for metabolic complications. Call your health care provider right away if you are experiencing symptoms of lactic acidosis.

What Causes Lipodystrophy?

Scientists have many theories about what causes lipodystrophy and research in this area is ongoing. However, the exact causes of lipodystrophy are still unknown. There may be different causes for different symptoms. It is important to know that the HIV drugs that are most likely to cause the different types of lipodystrophy listed below are older HIV drugs that are rarely used today.

• Fat loss: Research shows that certain HIV drugs from the nucleoside reverse transcriptase inhibitor (NRTI) class are the main cause of fat loss. These drugs are Retrovir (zidovudine, AZT or ZDV) and Zerit (stavudine, d4T).
• Fat gain: It is less clear what causes fat gain. Taking protease inhibitors (PIs), another class of HIV drug, may increase the risk of fat accumulation. Another theory is that insulin resistance and increased lipid levels play a role in fat gain.
• Increased lipids: Some of the PIs are believed to increase lipid levels, especially the first available, older PIs, such as Crixivan (indinavir) and Kaletra (lopinavir plus ritonavir)
• Increased glucose levels, insulin resistance, and diabetes: Both PIs and NRTIs have been linked to insulin resistance and diabetes
• Lactic acidosis: Some of the NRTIs are associated with lactic acidosis, especially Zerit and Videx (didanosine, ddI)

Not everyone taking HIV drugs develops body shape changes or problems with fat or sugar levels in the blood. Researchers have been looking for other factors that may cause lipodystrophy. The following appear to be risk factors:

• Starting HIV treatment with lower CD4 cell counts
• Starting HIV treatment at an older age
• Being on an HIV drug regimen containing certain PIs and NRTIs (the longer the time on the regimen the higher the risk)
• HIV itself
• Cigarette smoking