How can these physical abnormalities in HIV be treated?

How can these physical abnormalities in HIV be treated?

There is a lack of information about the cause of these abnormalities and predictors of who will or will not develop them. Moreover, there is no good evidence as to what can be done when the problems develop. All of this has made it very difficult for clinicians to counsel patients regarding treatment. At this time, in my opinion, it is appropriate to explain to HIV patients that: All individuals with HIV infection are at risk for developing these physical changes. No antiviral regimen can be used that would assure patients that these changes will not occur. If changes do occur, there are no clear strategies for reversing the problem.

Changing therapies and even stopping treatment has only rarely resulted in reversal of these physical abnormalities. Most other management strategies have focused on dealing with the fat accumulation syndromes. For example, diet and exercise does result in some decrease in belly (abdominal) fat. Similarly, many patients have had plastic surgery to remove fat collections around the neck.

Growth hormone injections have also been shown in small studies to reduce fat collections on the back of the neck and in the abdomen. However, growth hormone is expensive, needs to be used continually, and must be used cautiously because of potential toxicities. In addition, antidiabetes drugs that alter the body's handling (metabolism) of fat are being studied in certain patients with increased abdominal fat. The fat loss syndromes that result in sunken cheeks and prominent veins in the arms and legs have been more difficult to manage. Temporary benefits, however, have been seen with various forms of plastic surgery for sunken cheeks.