Can Lipodystrophy Be Treated?

Can Lipodystrophy Be Treated?

At this time, there is no simple treatment for lipodystrophy. However, there are a number of approaches that are being used to treat some of the symptoms.

Fat Loss

• Switching or avoiding Zerit and Retrovir: People who have not developed fat loss should avoid taking the NRTIs Zerit or Retrovir to prevent the condition. People who have fat loss can switch these drugs for others in the same class (either Viread [tenofovir] or Ziagen [abacavir]). The results of switching drugs are uncertain and may take some time; you and your health care provider may decide that changing medications is not right for you. Be sure to talk with your health care provider before stopping or switching any medications.
• Injections, implants, and plastic surgery: Some people have procedures done to restore fullness in the face. Injections of fat or synthetic fat substitutes can fill out sunken cheeks, as can cosmetic cheek implants. However, many of these treatments are still being studied and have not been approved by the Food and Drug Administration (FDA) for HIV-related lipodystrophy. If you are considering plastic surgery, research the options carefully. Some treatments are short-term, can be very expensive, and don't work for everyone. It is important to consult with a plastic surgeon or dermatologist experienced in treating HIV-related lipodystrophy. Also find out if your insurance company will cover plastic surgery.

Fat Gain

• Human growth hormone (HGH): HGH may decrease excess fat build up in the stomach; however, it can also cause fat loss in the arms, legs, or face. Two drugs, a synthetic human growth hormone (Serostim) and a synthetic growth hormone releasing factor (tesamorelin), have shown the ability to reduce fat build up in studies, but are not FDA approved for use in HIV-related lipodystrophy.
• Liposuction: Liposuction is a plastic surgery procedure that can be used to remove fat from the back of the neck and around the breasts, but not usually in the stomach (since fat gain caused by lipodystrophy in this area is deep, internal fat). Liposuction tends to be a temporary solution and the unwanted fat frequently returns. It can also be painful and is generally not covered by health insurance plans, although some people have had some success getting reimbursed for this expensive procedure.

Increased Lipids

• Switching HIV drugs: There are some HIV drugs that have less of an impact on cholesterol and triglycerides. These include Viramune (nevirapine), Intelence (etravirine), Isentress (raltegravir), and Selzentry (maraviroc). Reyataz and Prezista (darunavir) are also less likely to increase lipids, but both require use with Norvir (ritonavir), and Norvir does increase lipids.
• Lipid-lowering medications: There are drugs available to reduce lipid levels. Some lipid-lowering medications interact with HIV drugs, so have your health care provider review all your medications before prescribing anything.

Increased Glucose Levels, Insulin Resistance, and Diabetes

• Switching HIV drugs: Switching to other HIV drugs may reduce glucose levels. Speak to your health care provider about this option before stopping any medications.
• Medications: There are some drugs that can be used to treat these conditions, such as Glucophage (metformin).

All Symptoms of Lipodystrophy

• Diet and exercise: Increasing exercise and improving your diet may help with all of the symptoms of lipodystrophy. Exercise can help reduce fat gain, build muscle, and reduce elevated lipid and glucose levels.

Lowering the amount of saturated fats (found in animal products) may help reduce cholesterol levels. Lowering the amount of fats and carbohydrates may help reduce triglyceride levels. Some health care providers recommend more fiber in the diet to help control insulin resistance and help decrease stomach fat.

While there is no definite proof that these methods will improve lipodystrophy, there is no down side to eating right and exercising. It is a good idea to speak with a nutritionist or dietician about the steps you can take to improve your diet and exercise habits.

See the TWP sheets on lipodystrophy treatments, nutrition, and exercise for more information.

Caring for Yourself

If you are experiencing lipodystrophy it is especially important to take care of your body. Keep all of your doctor's appointments, get regular lab tests, and tell your doctor about any changes in the way you feel or in your body shape. Recording body measurements and weight on a regular basis, whether or not you are taking HIV medications, may give you valuable information down the road.

Some of these body shape changes and metabolic problems have been linked with heart disease and strokes in HIV+ people, so make sure you are monitored closely. Other factors also contribute to the risk of heart attacks and strokes, including high blood pressure. If you have high blood pressure, make sure it is treated. You can also support your body, and especially your heart, with a healthy diet, regular exercise, and giving up smoking.

Even though the physical changes of lipodystrophy can cause emotional distress, no researcher has suggested that people with lipodystrophy should stop taking their HIV medications. If you are concerned about your appearance, speak to your health care provider before making any changes to your HIV medication schedule that might jeopardize your health.