Treatment for lipodystrophy
When it comes to tackling both the physical and metabolic changes (such as high fats or sugars in the blood) associated with lipodystrophy, you should first have a comprehensive discussion with your doctor. You should discuss your HIV medication history, as well as your personal and family medical history, particularly any incidence of high lipid counts, diabetes or insulin resistance, and heart disease.
Equally important is how you feel about the changes in your body—how they are affecting your self-esteem, your relationships, and your ability to do your work and the things you enjoy. Part of the treatment may be a referral to some form of psychological counseling to help you deal with living with the condition on an emotional level.
Since it's pretty rare these days for people to take any of the older ARVs that are implicated in causing lipoatrophy, switching HIV medications is unlikely to affect that condition. Even when people were taking those ARVs, going off of them only meant the potential for modest and slow return of limb fat.
The changes in fat distribution resulting from both lipoatrophy and lipodystrophy are generally permanent.
However, there are options for reconstruction through plastic surgery, and some other treatment options for fat gain in particular. There are also lifestyle changes you can make to improve your appearance and your overall health.
(For information on the treatment of facial lipoatrophy, click here.)
Diet and exercise
Eating a healthy diet and exercising regularly may help you build up lean muscle mass and reduce unwanted fat build-up. Strength training, such as through weight-lifting, can also help improve your overall ratio of muscle to fat. Engaging in regular cardiovascular exercise may help reduce the accumulation of belly fat, and can likely do so without affecting lipoatrophy (fat loss). Regular exercise can also help regulate cholesterol, triglycerides and sugar in the blood. It's best to avoid rapid weight loss, because you'll risk losing vital lean body mass.
Consider consulting with a registered dietician to devise the best nutritional strategy to help you combat changes associated with lipodystrophy, as well as any unwanted shifts in the fats and sugars circulating in your body. It's a good idea to eat less saturated fat (not all fat, just saturated fat—an important distinction), limit your sugar intake, and cut back on alcohol. Eating less saturated fat may help lower your cholesterol too.
Treatment for Fat Gain
Egrifta is a synthetic growth hormone-releasing factor analogue. In 2010, the U.S. Food and Drug Administration (FDA) approved the drug to treat excess abdominal fat in people with HIV experiencing lipodystrophy. On average, the daily injectable drug reduces belly fat by about 18 percent over a one-year period. Some who take the drug have a better response than others. Once individuals stop taking the drug, any lost belly fat will rapidly return. Side effects include joint pain, redness and rash at the injection site, stomach pain, swelling and muscle pain. Additionally, Egrifta may cause blood sugar to rise.
Serostim is a daily injectable human growth hormone. It was approved by the FDA in 1996 to treat HIV-related wasting, and may reduce visceral fat around the organs (belly fat)The most common side effects include muscle or bone pain and swelling in the hands and feet. Some people taking Serostim develop carpal tunnel syndrome, a painful condition in the hands and fingers.
This procedure is an option for the fat pad on the upper back/neck (buffalo hump), although the fat often returns. Liposuction is not a possibility for reducing belly fat, because that fat is around the organs, as opposed to directly under the skin (subcutaneous). It is too dangerous to try to suck out fat from so deep in the abdomen.
Breast reduction surgery can reduce fat accumulation in the breast, both for men and women. However, the fat often returns.
Treat increased lipids
Consider switching HIV meds. Some ARVs are believed to have less of an effect on cholesterol and triglycerides than others.
Statins are common drugs are used to control cholesterol levels. They also lower triglycerides.
Treat high blood sugar, insulin resistance and diabetes
- Niacin: Increases HDL ("good") cholesterol, lowers triglycerides
- Fibrates: Lower triglycerides, also affect cholesterol.
Various medications can treat these health conditions. You may want to consider switching HIV meds. A change in your ARV regimen may improve your glucose levels.
In 2014, the FDA approved this injectable, synthetic version of the hormone leptin to treat lipodystrophy. In a clinical trial, those taking the drug showed improved measures in their blood sugar and triglycerides. Side effects include headache, low blood sugar, weight loss and belly pain. The drug can also increase the risk of lymphoma.
Among HIV-positive people with insulin resistance, the drug metformin has shown moderate success treating belly fat accumulation. However, it may cause lipoatrophy symptoms to progress. Those with chronic liver or kidney disease need to use caution when taking the drug.
You may want to consider psychological counseling to help you cope with how the physical changes of lipodystrophy are affecting your everyday life, your emotions, your relationships, and so on.