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HIV and AIDS

Update on Lipodystrophy in HIV

Summary & Participants

Fat changes known as lipodystrophy can be very disturbing to people receiving antiretroviral therapy for HIV. Listen to experts discuss some important preliminary data showing some features of lipodystrophy may be reversible.

Medically Reviewed On: May 09, 2008

Webcast Transcript

KEN LICHTENSTEIN, MD: The individual, when they first come into the clinic, the most obvious thing would be that they would have loss of fat on their face, namely over the cheeks.

ANNOUNCER: Many people receiving treatment for HIV experience one or more symptoms of a condition commonly called lipodystrophy.

KEN LICHTENSTEIN, MD: If you examine people further, you'll find that they have lost fat on their arms and their legs, and you see very well defined muscles because, again, the fat is not covering them.

ANNOUNCER: Other symptoms include the accumulation of fat in the abdomen, high levels of cholesterol, and insulin resistance, which can lead to diabetes.

In fact, there are so many aspects of what people have been calling "lipodystrophy," a recent trend among doctors is to focus on individual components.

WILLIAM POWDERLY, MD: One of the things that has emerged over the last year has been the recognition that there isn't a single syndrome. So rather than say, "What is lipodystrophy," it's better to say, "What are the things that we recognize as part of that problem?"

ANNOUNCER: Another recent development among doctors who treat HIV is a recognition there is no simple cause of lipodystrophy.

A few years ago, there had been consensus - now shown to be wrong - that drugs in the class known as protease inhibitors were almost exclusively responsible for this problem.

WILLIAM POWDERLY, MD: The manifestations were first recognized when protease inhibitors started to be used. So, rather simplistically, there was an assumption that protease inhibitors were causing all the problems. What was forgotten is that protease inhibitors weren't used on their own.

ANNOUNCER: Doctors still believe some protease inhibitors are associated with some lipodystrophy symptoms... specifically elevated cholesterol, insulin resistance and the accumulation of fat.

Research now shows that other drugs, known as nucleoside reverse transcriptase inhibitors, may contribute to the loss of fat.

But mostly, the research points away from generalizations.

KEN LICHTENSTEIN, MD: I think what we are finding out is that rather than protease inhibitors cause one toxicity, nucleoside analogs cause another. It turns out that probably there are more specific effects, more specific drug effects, so that various drugs within the same class may not cause the same kinds of toxicities.

ANNOUNCER: One ongoing research project, called the HIV Outpatient Study, or HOPS, has helped doctors better understand factors associated with higher risk of developing lipodystrophy.

KEN LICHTENSTEIN, MD: We find that there are what we call host factors that are associated with it, disease factors that are associated with it and drug factors that are associated with it.

ANNOUNCER: One set of recently-released data focuses on fat loss, also called "lipoatrophy."

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