Lipodystrophy

Lipodystrophy is the name given to a cluster of body changes that sometimes occur in people living with HIV, especially people taking antiretroviral drugs. We don't know exactly what causes it and not everyone agrees on a definition. Antiretrovirals certainly play a major role, but HIV itself may also contribute. You may experience an increase in fat in some areas (breasts, belly and neck) and a loss of fat in other areas (face, arms, legs, or butt). Sometimes, your overall body weight can stay the same, but your body shape can change significantly. Both men and women can experience all of these symptoms, but we're more likely than men to have fat accumulation -- particularly in the abdomen and breasts.

In addition to changes in body shape, some people experience changes inside the body, too. Fats in the blood, like cholesterol and triglycerides, can increase. Sometimes, the body becomes less able to process glucose and may become diabetic. Women who are overweight, don't exercise, smoke, and/or are over 40 are already at higher risk for diabetes and heart disease, even without lipodystrophy. So it's very important -- especially if you're taking combination therapy -- to monitor your lipid and glucose levels through regular bloodwork. Cholesterol and triglyceride measurements are most accurate if you don't eat at least 10-12 hours before having your blood drawn. This usually means a morning blood draw.

It's still not entirely clear what to do about lipodystrophy. Some people with increased cholesterol, triglycerides, or glucose levels stop taking their antiretrovirals or switch them, but this isn't possible for everyone. Plus, there's not a lot of evidence yet that switching regimens necessarily helps. There are medications that help control diabetes, and cholesterol/triglyceride levels. Researchers are exploring many possible options, including hormone therapy, liposuction, and implants for the face.

One thing you can do for yourself is maintain a good diet and exercise regularly -- at least three times a week. Exercise doesn't have to involve joining a gym; there are many ways to get your body moving without using a gym. Dietary changes that support your heart health include eating less animal fats like butter, cheese, and red meat, and adding more fish oil (especially salmon and sardines), nuts, whole grain cereals and breads. You may also want to reduce or try to quit smoking, and avoid progesterone-dominant birth control pills. Some women experience one or more of the symptoms of lipodystrophy, while others experience all of them. In addition to checking lipid levels, try to pay attention to your overall body shape (how your clothes fit is generally a good guide) and tell your provider about any changes you notice, however small they may seem.