HIV

Q: Will HIV medicines cause changes to your fat and stomach?

The loss of fat in the face, arms, and legs (lipoatrophy) and gain of fat in the belly (lipohypertrophy) and other places in the body (such as at the top of the back, causing a "buffalo hump") were dreaded complications of the older HIV treatments. Some of these body changes may be caused by HIV medicines, but they rarely occur with the medicines that are currently used.

Lipoatrophy is most common with medicines such as d4T (stavudine, Zerit) and AZT (ZDV, zidovudine), which are infrequently used (and are not recommended) in the United States at present. The accumulation of fat in the abdomen may be an effect of HIV, but it is also seen with protease inhibitors such as indinavir (Crixivan), which also is rarely used (and not recommended) these days. Therefore, people in the United States who start taking HIV medicines for the first time should not be concerned that they will have unwanted body changes from these medications. On the contrary, many people report that they feel and look healthier once they start taking HIV medications.

People who have already experienced body changes caused by older HIV medications should talk to their providers about the possibility of changing to medicines that may have less impact on fat loss or gain but still control HIV effectively. Fat loss resulting from those older HIV medicines usually does not continue when the offending medicine is discontinued, but some of the changes may be irreversible. There are treatments for facial lipoatrophy, including injections of dermal fillers that can lessen the appearance of these changes. Abdominal fat gain can be reduced in part by diet and exercise, as well as by avoidance of the older medications that may contribute to that change, and specific medical treatments may be appropriate.