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

November 13, 2015

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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 article 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). Zerit is an older HIV drug that is rarely used today.


Fat Loss in the Face

While lipoatrophy can occur in the arms, legs, and butt, fat loss in the face can be the most difficult for people living with HIV. 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 living with 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 have not been approved by the US Food and Drug Administration (FDA) for HIV-related lipodystrophy. Some of them have been approved by the FDA for other conditions or purposes. 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 people living with HIV have been able to convince their insurance companies or health services to cover the treatment. If you try to get your insurance company or health service 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, in the US, Medicare pays for facial fillers (Sculptra and Radiesse, below) for people living with HIV 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

The FDA approved Artefill for the treatment of facial wrinkles, lines, and furrows, but not for HIV-related facial lipoatrophy. Precise and Metacrill have not been evaluated by the FDA. Most people living with HIV treated with either Precise or Metacrill go to Mexico or Brazil to receive treatment. The cost varies, depending on the brand, the amount of filler needed, and travel expenses for Precise or Metacrill.

When considering permanent facial fillers, it is important to remember that our faces age -- what looks good now may not be what helps us look good two, five, or ten years from now.


Taking Care of Yourself

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.




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