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

Table of Contents

• Introduction
• Treatments for Fat Gain
• Taking Care of Yourself

Introduction

Fat is needed for the body to function. It plays an important role in keeping the skin and hair healthy, protecting body organs, and maintaining body temperature. Fat is also stored energy.

There are different types of fat found in the body. Visceral fat is located deep in the belly under the muscle. Subcutaneous fat is the layer of fat just under the skin. Lipids are fats or fat-like substances in the blood, such as cholesterol and triglycerides.

Lipodystrophy means abnormal fat changes. It is used to describe a number of potentially unhealthy changes including:

• Body shape changes
  • Lipohypertrophy: Fat gain in the breasts or back of the neck (buffalo hump); visceral fat gain in the belly; round lumps that appear under the skin (lipomas)
  • Lipoatrophy: Loss of subcutaneous fat in the arms, legs, butt, or face (sunken cheeks)
• Blood fat and sugar changes (metabolic problems)
  • Increased fats (lipids) in the blood
  • Increased sugar (glucose) in the blood

HIV+ people with lipodystrophy can have both body shape changes and metabolic problems. Some treatments can help with certain lipodystrophy changes, but no existing treatment gets rid of them all.

This info sheet looks at treatments for fat gain. See also Lipodystrophy Treatments Part II: Treatments for Fat Loss, and Lipodystrophy Treatments Part III: Treatments for Metabolic Changes.

Treatments for Fat Gain

Fat gain, especially visceral fat in the belly, can cause a number of problems. First, belly fat can make people feel badly about how their bodies look and can lead to depression. Many people living with HIV believe that the fat gain or fat loss of lipodystrophy marks them as HIV+ and increases the stigma they face. Second, additional belly fat can lead to bloating, tiredness, and heart problems. Fat gain not only affects the way people look, but it can also be harmful to your health.

No one is really sure what causes fat gain in people living with HIV. Sometimes it happens when a person puts on weight because of lack of exercise or getting older. However, fat gain may also be linked to the use of certain HIV drugs, including protease inhibitors. There are several treatments being explored for HIV-related fat gain.

Human Growth Hormone

Human growth hormone (HGH) is naturally produced in the human body. Two drugs have been developed based on HGH that have shown the ability to reduce visceral belly fat:

• Serostim: This drug is a man-made version of HGH
• Egrifta (tesamorelin): This drug is a man-made growth hormone releasing factor, which causes the body to produce more HGH

Serostim is taken by injection under the skin every day or every-other-day. If the drug is stopped, the visceral fat comes back. The main side effects are joint aches, water retention, increased lipoatrophy, and increased blood sugar levels, including diabetes.

Serostim is approved by the Food and Drug Administration (FDA) to treat HIV wasting, but not HIV-related fat lipodystrophy. The FDA said there was not enough safety and efficacy data to approve it to treat lipodystrophy, especially for long-term use.

Since Serostim is not approved for HIV-related fat gain, it will not be covered by insurance for this purpose. It is expensive, costing up to $3,000 a month. There is a patient assistance program for Serostim at www.serostim.com/treating-hiv-associated-wasting/pharmacy-info-and-assistance.aspx.

Egrifta has also been shown to decrease visceral belly fat. Like Serostim, people who stopped Egrifta had their belly fat return. Egrifta requires daily injections, but seems to have milder side effects than Serostim. It does not increase blood sugar or cause lipoatrophy, and it may lower triglycerides.

Egrifta was approved for HIV-related lipodystrophy in 2010. Check with your insurance company to see if they cover Egrifta. If you need assistance paying for this drug, go to www.needymeds.org/program_list.taf?_function=name&program_id=1348 for more information.

Over-the counter nutritional human growth hormone supplements are often advertized. Beware of these -- there is neither proof that they work nor proof that they are safe.

Leptin

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 32 percent after six months, with no change in subcutaneous fat. Small studies have not shown leptin to have negative effects on blood sugar.

Activists are asking the manufacturer of leptin to do larger studies in HIV+ people.