HIV/AIDS and Lipodystrophy Treatments Part I: Treatments for Fat Gain
September 22, 2014
Leptin is a hormone that is produced by fat cells. High levels of leptin suppress appetite and cause more fat to be used up.
Leptin treatment requires two injections under the skin a day, although other doses may be studied in the future. In a small trial of HIV+ men with lipodystrophy, visceral fat decreased by almost one third after six months, with no change in subcutaneous fat. In February 2014, the FDA approved the use of Myalept (metreleptin, the drug form of the hormone leptin) for lipodystrophy. The most common side effects include headache, low blood sugar, and belly pain. In addition, Myalept can increase people's risk of developing lymphoma, a type of blood cancer.
This diabetes drug showed promise in reducing belly fat in early studies. However, later studies showed conflicting results. Glucophage may also cause a rare but serious, life-threatening condition called lactic acidosis. As a result, it is recommended that women who may be at risk for diabetes discuss the pros and cons of using Glucophage with their health care providers.
These products are not recommended and not proven to be effective in HIV+ people. They usually contain stimulants that decrease appetite and make it more difficult to sleep. They can also increase blood pressure and make heart disease worse.
Synthetic testosterone has been studied as a treatment for lipodystrophy. One study of testosterone gel (Androgel) in HIV+ men showed no decrease in visceral belly fat. In fact, visceral fat increased and lipoatrophy in the arms and legs increased as well.
Oxandrin is an anabolic steroid that is taken by mouth. Anabolic steroids are synthetic steroid hormones that look and act a lot like testosterone. In a small study, it decreased visceral fat. However, it also made LDL ("bad") cholesterol go up and HDL ("good") cholesterol go down, and was accompanied by a small drop in subcutaneous fat. No body fat studies have been done with the other commonly-used anabolic steroid, nandrolone decanoate.
Ultrasound-assisted liposuction has been successfully used to remove fat accumulation in the back of the neck (buffalo hump). Liposuction for this purpose has a good track record of insurance coverage when health care providers justify it due to pain or sleep disorders. In some cases, however, the hump may return after a few months. Liposuction should not be used for removing visceral fat in the belly, since the procedure is designed to remove fat under the skin and not deep down around the organs.
Nutrition and Physical Activity
Strong studies are lacking in this area. However, in one study, nutrition and lifestyle changes resulted in decreased belly fat in people living with HIV. More research is needed on low-carbohydrate diets, which have been shown to improve blood sugar problems and visceral fat in HIV-negative people.
Cardiovascular (aerobic) exercise and resistance (strength or weight) training decreased triglycerides and visceral fat in a small study of HIV+ people. Another study showed that resistance training decreased fat, while improving cholesterol and triglycerides.
Cardiovascular exercise is any physical activity that increases your heart rate. Examples include walking at a fast pace, jogging, roller blading, dancing, and climbing stairs. In a gym you can also use treadmills, elliptical machines, and stair climbers.
Resistance training consists of using weights to improve muscle strength and growth. Examples include push-ups, squats, and the use of free weights and machines at the gym.
The US Department of Health and Human Services (DHHS) recommends at least 30 minutes of moderate intensity aerobic activity five times a week and strength or resistance training twice a week. It is a good idea to check with your health care provider if you are going to start an activity program to make sure you get off to a good start and do not hurt yourself. For more information, see The Well Project's article, Physical Activity, Exercise, and HIV.
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 body.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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