HIV and lipodystrophy
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 the face, arms, legs, or buttocks. You may also accumulate fat (called hyperadiposity or lipodeposition) in some areas, most commonly the back of the neck, breasts, and abdomen.
There are several approaches to managing the condition and changes in appearance.
Switching your HIV medications
Some HIV medications, such as protease inhibitors and nucleoside reverse transcriptase inhibitors, are known to cause lipodystrophy. If this is the case for you, the easiest solution is to switch medications. Taking a different medication can stop the progression of lipodystrophy and may even reverse some of the changes.
However, changing 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.
Exercise and a healthy diet
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 fatty acids, fruits and vegetables, and fiber. Avoid foods that are high in calories and carbohydrates but low in nutritional value.
Exercise may help your body regulate insulin and burn off extra calories. Aerobic and strength-building exercises help 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 per day, you’ll have to inject it into your abdomen. Side effects may include redness or rash, swelling, or muscle and joint pain.
The drug metformin is also used in people with HIV and type 2 diabetes. It has the added benefit of reducing both visceral and abdominal fat. The drug may also reduce subcutaneous fat deposits. This effect can be a problem in people with lipoatrophy, however.
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, as well.
Fat can be transplanted from one part of your body to another. By using your own fat, you face a lower risk of allergic reaction or rejection.
In a procedure similar to liposuction, fat is taken from the abdomen, thighs, buttocks, or hips. It is then cleaned and filtered. Your surgeon will inject or implant it in another area, most commonly the face.
Fat can also be frozen for later use.
Poly-L-lactic acid (Sculptra or 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. After, you’re 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’s usually necessary to repeat the procedure after 1 to 2 years.
Calcium hydroxyapatite (Radiesse, Radiance) is a soft-tissue filler. It’s FDA-approved for treatment of lipoatrophy in people who are HIV-positive.
During the procedure, your doctor will insert a needle into your skin. They’ll slowly inject the filler 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 your procedure. Not all of these methods are recommended for people who are HIV-positive, either. Ask your doctor about the possible risks of these substances and procedures.