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HIV/AIDS and Lipodystrophy Treatments Part II: Treatments for Fat Loss

May 2012

Table of Contents


Fat in the Body

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:

People living with HIV (HIV+) who have 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 all of them.

This info sheet looks at treatments for fat loss or lipoatrophy. See also Lipodystrophy Treatments Part I: Treatments for Fat Gain and Lipodystrophy Treatments Part III: Treatments for Metabolic Changes.


Switching HIV Drugs

Some HIV drugs in the non-nucleoside reverse transcriptase (NRTI) class have been linked to subcutaneous fat loss, including Zerit (stavudine, d4T) and Retrovir (zidovudine, AZT).


Fat Loss in the Face

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While lipoatrophy can occur in the arms, legs, and butt, fat loss in the face can be the most difficult for HIV+ people. This can make someone look older and sicker than they are and cause embarrassment and low self-esteem. Many people living with HIV also believe that facial fat loss marks them as HIV+ and increases the stigma they face.

There are a number of treatments available. They all involve having products injected or surgically implanted to fill out hollows in the face. This can restore facial fullness. Temporary and permanent fillers are available. Temporary fillers usually last from three to 12 months and usually require touch-ups. Permanent fillers provide long-lasting results, but generally cannot be removed if the outcome is not good.

Many of these fillers are still being studied and have not been approved by the US Food and Drug Administration (FDA) for HIV-related lipodystrophy. If you are considering a treatment, get as much information as you can about the choices available to you. The long-term effects are unknown and results can be different from person to person.

It is important to consult with a plastic surgeon or dermatologist experienced in treating HIV-related lipodystrophy. If you are planning on using a treatment, and especially if you plan to go outside of the US to get it, check with the product's manufacturer to make sure your provider has been properly trained to perform the procedure.

The treatments are expensive and many insurance companies will not provide coverage. However, some HIV+ people have been able to convince their insurance companies to cover the treatment. If you try to get your insurance company to pay for these treatments, it is important to stress to them that fillers are required to restore facial features lost to HIV drug treatment, not simply for cosmetic purposes.

On a positive note, Medicare pays for facial fillers (Sculptra and Radiesse, below) for HIV+ people on Medicare who experience symptoms of depression due to HIV-related facial lipoatrophy. This decision was made, in part, because studies showed that the fillers can improve self-image, ease symptoms of depression, and help people stick more closely to their HIV drug treatment schedules.


Temporary Facial Fillers


Permanent Facial Fillers


Taking Care of Yourself

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

It may also be a good idea to get a BIA (Bioelectrical Impedance Analysis). A BIA is an easy and painless test that gives 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.




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