for Veterans and the Public

Body Shape Changes with HIV: Entire Lession

People who are taking HIV medicines and living longer sometimes experience visible changes in body shape and appearance. This condition is called lipodystrophy (pronounced "li-po-dis-tro-fee"). "Lipo" means fat, "dystrophy" means abnormal growth or change. So, lipodystrophy means abnormal changes in fat. These changes can be caused by HIV itself or by HIV medications.

These changes were much more common with older HIV medications. Current HIV medicines are much less likely to cause body changes and many people experience no body changes at all.

Lipodystrophy involves two types of fat in the body. One type, called visceral fat, lines internal organs. Too much visceral fat can put a person at risk of a heart attack, stroke, or diabetes.

The other type, called subcutaneous fat, is right under the skin. This fat can be lost in HIV, leading to prominent veins in the arms and legs and changes in facial appearance. Loss of subcutaneous fat is not life threatening but can have serious effects on the way people see themselves. It can lead to depression, anxiety, and low self-esteem.

Fat gain in the belly

A person may gain a large amount of visceral fat around the organs in their belly. This causes the abdomen to look swollen and feel hard. (If the abdomen is soft or doughy, it probably has nothing to do with HIV or its treatment.)

Gain in visceral fat can prevent organs from working properly. This can affect how sugar and fats are processed in the body. Some people also show an increased amount of fat (called lipids) in their blood, particularly cholesterol and triglycerides. Increased cholesterol can raise the risk of a heart attack or stroke. Increased triglycerides can raise the risk of damage to the pancreas.

Blood sugar levels may go up, and the body may become less sensitive to insulin. This can lead to diabetes.

Possible changes in body fats and sugars:

• changes in cholesterol ("bad" LDL cholesterol goes up, "good" HDL cholesterol goes down)
• increase in triglyceride levels
• increase in blood sugar levels
• less sensitivity to insulin

Exercise may be able to lessen the fat deposits around the gut. Diet can help lower the blood fats (cholesterol and triglycerides) that increase the risk of heart disease.

Fat around neck, shoulders, breasts, and face

Another change is fat buildup on the back of the shoulders and neck (sometimes called a "buffalo hump"). Fat on the back of the neck doesn't raise the risk of heart disease but can cause headaches and sometimes problems with breathing and sleeping.

Fat gain can make breasts bigger, which can cause back pain. Women seem more likely than men to experience greater fat gain in the breasts and the abdomen.

Fat accumulation also can make the face appear fuller.

Fat on the back of the neck

Fatty bumps on the body

Little fatty bumps called lipomas can appear under the skin anywhere on the body.

Some people lose fat, usually from the face, arms, legs, or buttocks. Cheeks may appear sunken. Muscles and veins in the legs may look bigger because there is less fat to hide them.

This fat loss is from the subcutaneous fat found just underneath the skin. These changes can affect a person's self-esteem, and can lead to depression and anxiety.

Fat loss in the face

Fat loss in the leg

Experts aren't sure whether these changes are due to HIV itself, or to the anti-HIV drugs. There are no proven cures at this time, but there are steps you can take to reduce the effects.

Plastic surgeons can use liposuction (sucking out the fat) on a buffalo hump. Liposuction, however, is not a good treatment for fat around the gut because of possible damage to the organs.

For fat loss in the face, doctors can inject fat or a fat-like substance to fill out sunken cheeks or other areas, such as around the eyes and mouth. In 2004, the U.S. Food and Drug Administration approved the use of Sculptra™, an injectable product that can replace fat lost from the face. The VA is closely monitoring the data on Sculptra™ before deciding whether to approve it use within the VA.

If you are experiencing any of these changes, be sure to talk to your health provider about them. Finding a solution to these body shape changes is a major research effort, and new therapies may become available in the future.

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