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HIV/AIDS and Lipodystrophy Treatments Part III: Treatments for Metabolic Changes

October 1, 2014

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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 to use for 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; 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

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 metabolic complications. See also Lipodystrophy Treatments Part I: Treatments for Fat Gain and Lipodystrophy Treatments Part II: Treatments for Fat Loss.


Metabolic Problems

Many HIV+ people experience increases in blood fats (lipids) and blood sugar (glucose). There are many possible causes for these metabolic changes, including HIV itself and HIV drugs. Although you cannot see these changes, they can cause serious long-term health problems.

  • High lipid levels: High levels of blood fats such as cholesterol and triglycerides can increase your chances of having heart problems.
  • High glucose levels: When you eat, your body changes the food into glucose. Glucose is carried through the bloodstream to provide energy to all of your cells. In order for glucose to get into your cells, you need insulin. Insulin is a hormone made by the pancreas. If your body has a problem making or using insulin, glucose cannot get into your cells. As a result, glucose stays in the blood and the cells do not get enough. Some protease inhibitors (PIs) can make it difficult for insulin to get glucose into the cells. This is called insulin resistance. It can lead to pre-diabetes and diabetes. Pre-diabetes and diabetes are serious health conditions. For more information, see The Well Project's article on Diabetes.


Switching HIV Treatment

There are some HIV drugs that have less of an impact on cholesterol and triglycerides. These include Viramune (nevirapine), Intelence (etravirine), Edurant (rilpivirine), Isentress (raltegravir), and Selzentry (maraviroc). Reyataz (atazanavir) and Prezista (darunavir) are also less likely to increase lipids, but both are used with Norvir (ritonavir), and Norvir does increase lipids.

If you have high blood sugar levels, your health care provider may recommend that you change your HIV drugs. Some studies have shown that switching to a combination that does not include a PI can help bring these levels under control. Switching is not the best choice for everyone and it is important that you speak to your health care provider before stopping or switching any HIV drugs.

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Related Stories

Lipodystrophy Treatments Part I: Treatments for Fat Gain
Lipodystrophy Treatments Part II: Treatments for Fat Loss
An HIVer's Guide to Metabolic Complications
More on Lipodystrophy Treatment

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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 to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from 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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