HIV/AIDS & Lipodystrophy

HIV/AIDS & Lipodystrophy

Lipodystrophy is an abnormal distribution of body fat that occurs in patients who are on antiretroviral therapy. Patients taking antiretrovirals tend to lose fat on the arms, legs, buttocks, and face, and tend to accumulate fat around the belly and breasts. Some patients develop a fat lump on the back of the neck, which is called a "buffalo hump." Scattered lumps of fat that form under the skin are called lipomas.

It is estimated that 5–75% of patients taking antiretroviral drugs develop lipodystrophy. The exact cause of lipodystrophy is unknown. Initially, it was thought to be a side effect of protease inhibitors. Protease inhibitors may increase the speed at which this condition develops, but lipodystrophy also occurs in patients who do not take protease inhibitors. Risk factors include age, length of antiretroviral therapy (nucleosides in particular), race, and baseline level of fat.

Lipodystrophy is generally not a serious condition. Possible complications include an increased risk for heart disease, breast pain, headaches, and difficulty sleeping and breathing caused by "buffalo humps." Lipodystrophy often causes psychological and emotional problems and some patients stop taking antiretrovirals because they are so disconcerted with the way their body is changing.

Treatment for lipodystrophy includes exercise, low fat diet, anabolic steroids, growth hormone, and alteration of antiretroviral therapy. Patients who want to change their antiretroviral therapy should do so only under the strict supervision of an HIV specialist.

Recent studies have shown that as many as two-thirds of HIV patients in the United States are overweight or obese. The success of antiretroviral therapy, combined with unhealthy eating and exercise habits may contribute to obesity in patients with HIV.