Lipodystrophy: Your HIV Treatment in Pictures
Certain medications used to treat HIV can cause lipodystrophy.
Lipodystrophy is a condition that changes the way your body uses and stores fat. You may lose fat (called lipoatrophy) in some areas of your body—usually in the face, arms, legs, or buttocks. You may also accumulate fat (called hyperadiposity) in some areas, most commonly in the back of the neck, breasts, and abdomen.
These changes in appearance can cause anxiety, but don’t worry. There are several approaches to managing the condition.
Switch Your HIV Medications
Some HIV medications—such as protease inhibitors (Pls) and nucleoside reverse transcriptase inhibitors (NRTIs)—are known to cause lipodystrophy. If this is the case, the easiest solution is to switch medications. Taking a different medication can stop the progression and may even result in improvement.
However, stopping your medications is a decision that requires careful consideration of your overall health. Don’t just stop taking your medications! Ask your doctor if another medication is a better option for you.
The Role of Diet and Exercise
There is no specific diet for treatment of lipodystrophy. However, a healthy diet plays an important role in overall health and in maintaining a suitable body weight. Aim for a diet rich in omega-3, fruits and vegetables, and fiber.
Avoid foods that are high in calories and carbohydrates, but low in nutritional value. Though they may be tempting, fad diets or rapid weight-loss schemes will only stress you out.
Exercise may help your body’s ability to regulate insulin and burn off extra calories. Aerobic and strength-building exercises help to build strong muscles too.
In 2010, the U.S. Food and Drug Administration (FDA) approved a growth hormone releasing factor (GRF) called tesamorelin (Egrifta) for treatment of HIV lipodystrophy. The medication, which consists of powder and a diluting agent, must be stored in the refrigerator and away from light. You mix it together by rolling the vial in your hands for about 30 seconds. Once a day, you’ll have to inject it into your abdomen.
Side effects may include redness or rash, swelling, or muscle and joint pain.
Liposuction can remove fat from targeted areas. Your surgeon will mark your body before beginning. Either local or general anesthesia is required.
After injecting a sterile solution to help with fat removal, your surgeon will make tiny incisions to insert a tube under your skin. The tube is connected to a vacuum. Your doctor will use a back and forth motion to suction fat from your body.
Side effects may include swelling, bruising, numbness, or pain. Risks of surgery include puncture or infection. Fat deposits may eventually return.
Fat can be transplanted from one part of your body to another. In a procedure similar to liposuction, fat is harvested from the abdomen, thighs, buttocks, or hips. It is then cleaned and filtered. Your surgeon will inject or implant it where needed, most commonly the face.
Fat can also be frozen for later use. The big advantage is that by using your own fat, you face lower risk of allergic reaction or rejection.
Facial Filler: Poly-L-lactic Acid
Poly-L-lactic acid (Sculptra, New-Fill) is an FDA-approved facial filler that is injected into the face. The procedure is performed by a doctor. Your doctor may stretch the skin while slowly giving the injection. Following the injection, patients are generally given a 20-minute massage at the injection site. This helps the substance to settle into place. Ice is used to decrease swelling.
Side effects may include site pain or nodules. Risks include allergic reaction and injection site abscess or atrophy. It is usually necessary to repeat the procedure after a year or two.
Facial Filler: Calcium Hydroxylapatite
Calcium hydroxylapatite (Radiesse, Radiance) is a soft-tissue filler FDA-approved for treatment of lipoatrophy in those who are HIV positive.
During the procedure, your doctor will insert a needle into your skin and push the plunger. They’ll slowly inject the substance in linear threads while withdrawing the needle.
Side effects include injection site redness, bruising, numbness, and pain. The procedure may need to be repeated.
There are a variety of facial fillers in use today, including:
- polymethylmethacrylate (PMMA; Artecoll, Artefill)
- bovine collagens (Zyderm, Zyblast)
- human collagens (CosmoDerm, CosmoPlast)
- hyaluronic acid
These are temporary fillers, so it may be necessary to repeat the procedure. Not all of these methods are recommended for people who are HIV positive. Ask your doctor about the possible risks of these substances and procedures.
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