Side Effects of Anti-HIV Medications — Lipodystrophy
A Service of the U.S. Department of Health and Human Services Lipodystrophy What is lipodystrophy? Terms Used in This Fact Sheet:
Lipodystrophy, also called fat redistribution, is a
Baseline: an initial measurement made before starting
disturbance in the way your body produces, uses, and
therapy and used as a reference point.
stores fat. There are two different kinds of lipodystrophy.
Metabolic: referring to the buildup or breakdown of the
In fat wasting, also known as lipoatrophy, fat is lost
body's molecular building blocks. These building blocks
from particular areas of the body, especially the arms,
provide the material and energy that your body needs to function.
legs, face, and buttocks. The second kind of lipodystrophy is fat accumulation, also known as hyperadiposity. In
Magnetic resonance imaging (MRI): a way to take pictures of the inside of the body. MRI uses magnetic fields
fat accumulation, fat builds up in particular parts of the
and radio waves instead of x-rays. MRIs are particularly
body, especially the belly, breasts, and back of the neck.
useful for taking pictures of the body's soft tissues and organs. What does lipodystrophy look like? Non-nucleoside reverse transcriptase inhibitor (NNRTI): class of anti-HIV medication. NNRTIs work by blocking reverse transcriptase, a protein that HIV needs to make
• back of the neck and upper shoulders
copies of itself. The NNRTIs approved by the FDA are Rescriptor, Sustiva, and Viramune.
(often described as "buffalo hump")
Nucleoside reverse transcriptase inhibitor (NRTI): class of
• abdomen (also called "protease paunch"
anti-HIV medication. NRTIs are faulty versions of the building blocks (nucleosides) used by reverse transcriptase, a protein that HIV needs to make copies of
• lipomas (fatty growths in different parts of the body)
itself. The NRTIs approved by the FDA are Combivir, Emtriva, Epivir, Epzicom, Retrovir, Trizivir, Truvada, Videx, Viread, Zerit, and Ziagen. Protease inhibitor (PI): class of anti-HIV medication. PIs
• face (sunken cheeks, temples, and eyes)
work by blocking protease, a protein that HIV needs to
• arms and legs (veins may become more visible;
make copies of itself. The PIs approved by the FDA are Agenerase, Aptivus, Crixivan, Fortovase, Invirase, Kaletra, Lexiva, Norvir, Reyataz, and Viracept. Are there any other disorders that occur What causes lipodystrophy? along with lipodystrophy?
Early studies suggested that lipodystrophy was
If you have lipodystrophy, you may also have other
associated with the use of protease inhibitors (PIs), metabolic
a class of commonly prescribed anti-HIV drugs.
However, other studies have shown that lipodystrophy
also occurs in people who have never taken PIs.
Evidence now suggests that lipodystrophy is linked to
taking nucleoside reverse transcriptase inhibitors
and insulin resistance is called lipodystrophy syndrome.
(NRTIs) and PIs at the same time. of Antiretroviral Agents in HIV-Infected Adults and AdolescentsSide Effects of Anti-HIV Medications — Lipodystrophy
A Service of the U.S. Department of Health and Human Services Lipodystrophy (continued)
Other risk factors for lipodystrophy include:
• age—older people are at higher risk for lipodystrophy
How is lipodystrophy treated?
• race—whites are at higher risk for lipodystrophy
At this time, there are no clearly effective treatments for
lipodystrophy. However, if you have lipodystrophy, you
sex—men are more likely to experience fat loss in
their arms and legs, while women tend to have an
• Changes to your anti-HIV medications—People with
lipodystrophy may benefit from changes to their HIV
• length and severity of HIV infection—the longer you
treatment regimens. If you are taking Zerit, switching
have been infected and the more severe your
to Ziagen (abacavir, ABC) may help reduce
infection, the higher your risk for lipodystrophy
lipodystrophy. PIs may be replaced with non-
• a baseline body mass index (BMI) in the obese range nucleoside reverse transcriptase inhibitors
or significant weight changes are risk factors for
(NNRTIs), which do not appear to cause
lipodystrophy. However, the results of switching drugs
• baseline immune system health and how well your
are uncertain; you and your doctor may decide that
immune system recovered after starting anti-HIV
changing medications is not right for you. Be sure to
talk with your doctor before stopping or switching any medications.
• Diet and exercise— Changes to your diet and exercise
Which anti-HIV drugs are most likely to
regimen may help build muscle and reduce fat
Zerit (stavudine, d4T) is one NRTI that has been
• Medications—If you have insulin resistance and are
specifically shown to cause fat loss. PIs may increase
the risk of fat accumulation. The longer you take NRTIs
and PIs, the greater your chance of developing
• Injections, implants, and surgery—If you have fat
wasting, you may benefit from injections of human growth hormone (hGH) to boost muscle size in your
How will my doctor and I know if I have
arms and legs. Injections of fat or synthetic fat
substitutes like Sculptra can fill out sunken cheeks, as can cosmetic cheek implants. However, most of these
A diagnosis of lipodystrophy is usually made by
treatments, along with surgery to remove fat
examining your body for fat changes. Your doctor may
accumulation, are still being studied and do not yet
measure around your arms, thighs, waist, hips, and neck
have FDA approval for the treatment of HIV-related
before you start medication and then periodically
lipodystrophy. Sculptra is the only treatment that is
throughout your treatment. Abdominal magnetic resonance imaging (MRI)
currently approved; it received FDA approval in
abdominal fat; however, there are currently no specific recommendations for routine assessment and monitoring of lipodystrophy.
For more information:
of Antiretroviral Agents in HIV-Infected Adults and Adolescents
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