Table of Contents
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
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
(lipoaccumulation or 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
HIV+ people 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
- Face (sunken cheeks)
Fat build up may happen in the:
- 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. It is important
that you talk to your health care provider if you are feeling this way so that
you take the necessary steps to improve your health.
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 (lactic acidemia)
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
- 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.
See TWP sheets on hyperlipidemia, diabetes and lactic acidosis for more information.
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.
- 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. It is still not clear which ones are
most likely to do this, but Reyataz (atazanavir or ATV) seems to be the least
likely PI to cause increased lipid levels
- 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
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
- 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
- White race
Can Lipodystrophy Be Treated?
At this time, there is no simple treatment for lipodystrophy. However, there
are a number of approaches that are being used to treat some of the
- Switching or avoiding Zerit and
Retrovir: People who have not developed fat loss should avoid taking
the NRTIs Zerit or Retrovir to prevent the condition. People who have fat loss
can switch these drugs for others in the same class (either Viread [tenofovir]
or Ziagen [abacavir]). The results of switching drugs are uncertain and may
take some time; you and your health care provider may decide that changing
medications is not right for you. Be sure to talk with your health care
provider before stopping or switching any medications.
- Injections, implants, and plastic
surgery: Some people have procedures done to restore fullness in the
face. Injections of fat or synthetic fat substitutes can fill out sunken
cheeks, as can cosmetic cheek implants. However, many of these treatments are
still being studied and have not been approved by the Food and Drug
Administration (FDA) for HIV-related lipodystrophy. If you are considering
plastic surgery, research the options carefully. Some treatments are
short-term, can be very expensive, and do not work for everyone. It is
important to consult with a plastic surgeon or dermatologist experienced in
treating HIV-related lipodystrophy. Also find out if your insurance company
will cover plastic surgery.
- For more information, see TWP info sheet on Lipodystrophy Treatments and Fat Loss
- Human growth hormone (HGH):
HGH may decrease excess fat build up in the stomach; however, it
can also cause fat loss in the arms, legs, or face. Two drugs, a synthetic
human growth hormone (Serostim) and a synthetic growth hormone releasing factor
called Egrifta (tesamorelin), have shown the ability to reduce fat build up in
studies. The FDA approved the use of Egrifta for HIV-related lipodystrophy in
- Liposuction: Liposuction is a
plastic surgery procedure that can be used to remove fat from the back of the
neck and around the breasts, but not usually in the stomach (since fat gain
caused by lipodystrophy in this area is deep, internal fat). Liposuction tends
to be a temporary solution and the removed fat frequently returns. It can also
be painful and is generally not covered by health insurance plans, although
some people have had some success getting reimbursed for this expensive
- For more information, see TWP info sheet on Lipodystrophy Treatments and Fat Gain
- Switching HIV drugs: There are some HIV drugs that have less of an impact on
cholesterol and triglycerides. These include Edurant (rilpivirine),Viramune
(nevirapine), Intelence (etravirine), Isentress (raltegravir), and Selzentry
(maraviroc). Reyataz and Prezista (darunavir) are also less likely to increase
lipids, but both require use with Norvir (ritonavir), and Norvir does increase
- Lipid-lowering medications:
There are drugs available to reduce lipid levels. Some lipid-lowering
medications interact with HIV drugs, so it is important for your health care
provider to review all your medications before prescribing anything.
- For more information, see TWP info sheet on Lipodystrophy Treatments and Metabolic Changes
Increased Glucose Levels, Insulin Resistance, and Diabetes
- Switching HIV drugs: Switching
to other HIV drugs may reduce glucose levels. Speak to your health care
provider about this option before stopping any medications.
- Medications: There are a
variety of drugs that can be used to treat these conditions; talk to your
health care provider about which ones might be right for you.
- For more information, see TWP info sheet on Lipodystrophy Treatments and Metabolic Changes
All Symptoms of Lipodystrophy
- Diet and physical activity:
Increasing physical activity and improving your diet
may help with all of the symptoms of lipodystrophy. Physical activity can help
reduce fat gain, build muscle, and reduce elevated lipid and glucose
Reducing the amount of saturated fats you eat may help reduce cholesterol
levels. Saturated fats are found in animal products. Reducing the amount of
fats and carbohydrates you eat may help reduce triglyceride levels. Some health
care providers also recommend more fiber in the diet to help control insulin
resistance and help decrease stomach fat.
While there is no definite proof that these methods will improve
lipodystrophy, there is no down side to eating right and exercising. It is a
good idea to speak with a nutritionist or dietician about the steps you can
take to improve your diet and level of physical activity.
Caring for Yourself
If you are experiencing lipodystrophy it is especially important to take
care of your body. Keep all of your appointments with your health care
provider, get regular lab tests, and tell your provider about any changes in the way you feel or
in your body shape. Recording body measurements and weight on a regular basis,
whether or not you are taking HIV medications, may give you valuable
information down the road.
Some of these body shape changes and metabolic problems have been linked
with heart disease and strokes in HIV+ people, so make sure you are checked
regularly. Other factors, such as high blood pressure, may also contribute to
the risk of heart attacks and strokes and need to be treated. You can also
support your body, and especially your heart, with a healthy diet,
physical activity, and stopping
Even though the physical changes of lipodystrophy can cause emotional distress, no researcher has suggested that people with
lipodystrophy should stop taking their HIV drugs. If you are concerned about
your appearance, talk to your health care provider about treatment options.
There are many things that you can do to stay healthy and feel good about your