HIV/AIDS and Lipodystrophy Treatments Part I: Treatments for Fat Gain

Glucophage (Metformin)

This diabetes drug showed promise in reducing belly fat in early studies. However, later studies showed conflicting results. 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.

Fat Burners

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.

Testosterone

Man-made 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.

Anabolic Steroids

Oxandrin is an anabolic steroid that is taken by mouth. 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.

Liposuction

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.

A regimen of an hour of strength or resistance training combined with 20 minutes of aerobic activity three to four times a week has been shown to work for most people. It is a good idea to check with your health care provider if you are going to start an exercise program to make sure you get off to a good start and do not hurt yourself.

Taking Care of Yourself

Some body shape changes and metabolic problems have been linked with heart disease and strokes in HIV+ people. To decrease your risk of heart disease and/or stroke:

• Get checked and, if needed, treated for high blood pressure
• Have regular lab tests to check your lipid and glucose levels
• Eat a healthy diet; see a dietician or nutritionist if you need help with this
• Get regular physical activity
• Stay at a healthy weight
• Stop smoking or cut down on how much you smoke
• For more information, see our info sheet on Caring for Your Heart

It may also be a good idea to get a BIA (Bioelectrical Impedance Analysis). A BIA is an easy and painless test that can give information about fat and lean body mass. Having BIAs done over time can be helpful in monitoring body shape changes.

If you are experiencing lipodystrophy, it is especially important to take care of yourself. Keep all of your medical appointments, get regular lab tests, and tell your health care provider about any changes in the way you feel or in your body shape. Do not make any changes to your medication regimen without your health care provider's guidance.