Treatment training manual

4. 7 Lipodystrophy (fat changes)

Lipodystrophy refers to changes in fat cells and the distribution of body fat.  It can also be linked to changes in blood fat and blood sugar levels.

Lipodystrophy is much less common with modern HIV drugs.

Lipodystrophy can result in losing fat from your arms, legs and face or gaining fat in your abdomen, breasts or shoulders.

We do not know what causes lipodystrophy. Different drugs may be responsible for fat gain and fat loss. Similar symptoms only occur rarely in HIV positive people who are not on treatment. Lipodystrophy usually, but not always, develops slowly over many months or years.

  • Early symptoms may reverse if you switch to different HIV drugs.
  • Exercise and dietary changes can also help.
  • Careful body measurements by a dietician, by DEXA scan, or photographs can monitor changes.
  • Blood tests can monitor changes in blood fats and blood sugar levels.

Fat gain

Fat gain – to the stomach or breasts and/or across the shoulders – has been more linked to protease inhibitors and non-nukes.

Fat loss (lipoatrophy)

Fat loss is also called lipoatrophy – and it occurs from arms, legs, face and buttocks.

Fat loss – was nearly always caused by an old HIV drug called d4T. Fat loss can also occur with AZT.

Neither d4T and AZT are recommended as first-line therapy in the WHO guidelines.

Changes to blood fats

Raised levels of blood fats (lipids) has been mainly linked to protease inhibitors. Raised blood fats increase the risk of heart disease. There are two kinds of blood fat: cholesterols and triglycerides.

Cholesterol is often categorised as “good” or “bad”. High density cholesterol (HDL) is good and low density choesterol (LDL) is generally bad.

The relationship of HDL to total cholesterol (TC) – called the HDL:TC ratio – is often used as a more important clinical test for monitoring.

Changes to blood sugars

High blood sugar levels are directly related to some protease inhibitors and possibly indirectly related to nukes through their effect on fat distribution.

High blood sugar is related to many long-term health problems, including type 2 diabetes (low sensitivity to insulin). Changes in blood sugar levels and low insulin sensitivity are closely related to other symptoms of lipodystrophy.

This important complication of HIV treatment often gets too little recognition.

Differences in men and women

Women are more likely to report symptoms of fat gain than fat loss.

Other studies tell us that people who start treatment when they are thin, fat loss appears worse. People who start treatment with a bigger build are more likely to report accumulation.

Further reading

Information about lipodystrophy and metabolic complications from the i-Base guide to side effects and other complications.

Information about fat loss (lipoatrophy) from the i-Base guide to side effects and other complications.

Information about fat accumulation from the i-Base guide to side effects and other complications.

Information about cholesterol and triglycerides from the i-Base guide to side effects and other complications.

Information about blood sugar and T2 diabetes from the i-Base guide to side effects and other complications.

Last updated: 1 January 2016.