Q and A


Which HIV drugs cause lipodystrophy?

I’m not on treatment yet but I am trying to learn about it before I start.

I am very worried about lipoatrophy and lipodistrophy. Can you tell me which is the best treatment combination for not producing these side effects?

From my reading the integrase inhibitor raltegravir (Isentress) and entry inhibitor maraviroc sound like the best option. What do you think?



It is good that you are looking at treatment options before starting treatment. Although lipoatrophy was a worry oin the past, none of the drugs used in 2016 for starting treatment  have this side effect.

Lipoatrophy is the term for fat loss and lipohypertrophy is the term for fat gain.

Lipodystrophy is a term for general changes in body fat, which includes fat loss and fat accumulation. Although everyone is likely to worry about this side effect, luckily the chance that it will occur is very low.

Body changes are reported less often with all the first line combinations in UK or US treatment guidelines. So these are side affects that related to when treatment was first developed 20 years ago.

Fat loss was almost entirely related to use of d4T (stavudine) or AZT (zidovudine) – neither of which are recommended in Western countries anymore.

Fat accumulation is more complex because it has been reported with all types of combinations. Although this was first linked with early protease inhibitors, it was also reported with NNRTIs like nevirapine and efavirenz.

It seemed plausible that drugs that increased blood lipids like cholesterol and triglcerides  might also be causing fat accumulation. So when newer lipid neutral drugs like atazanavir and raltegravir were developed it was hoped they would also not cause lipodystrophy.

However, this wasn’t seen in studies. Atazanavir, even unboosted by ritonavir, didn’t show less fat distribution compared to lopinavir/ritonavir (Kaletra), for example. Similarly, the hope that integrase inhibitors might have a clean lipodystrophy profile was not seen in studies, where raltegravir was similar to efavirenz.

The mechanism behind fat accumulation has still not been explained. Luckily fat accumulation seems much less common with little difference between efavirenz, atazanavir/ritonavir, darunavir/ritonavir or raltegravir, when any of these four first-line options are used with either tenofovir/FTC or abacavir/3TC.

Although maraviroc had less of an impact on cholesterol and triglycerides compared to efavirenz, I haven’t seen any reports of the impact on lipodystrophy. Also, maraviroc is not currently licensed for first-line therapy.

This means it is probably best to pick your choice based on other properties of these drugs, in discussion with your doctor, knowing that if you get side effects you could at lest switch to alternatives.

Frist line options are listed in the i-Base introduction to combination therapy, especially in the ‘which drug, which combination‘ section.

The i-Base guide to side effects includes about 14 pages on lipodystrophy and metabolic changes.

This answer was updated in January 2016 from a question first posted on 4 September 2012.


  1. Roy Trevelion

    Hi Mpho,

    Trenvir is a generic version of Atripla. There are rare reports that efavirenz, one of the drugs in Trenvir, can cause fat loss to the face and arms and legs. Please see this guide to fat loss.

    Please talk to your doctor and ask if switching HIV meds might help.

    If your weight loss is more general, you can also see this guide to a balanced diet and your health. There’s lots of info here about foods rich in calories and nutrients that could help you gain weight.

  2. Mpho

    Hi, i started taking Trenvir in November 2018 and since then i have been losing so much weight, i sweat at night, i get headaches, i have muscle pains, chest pains, back pains, which is very uncomfortable… worse thing is my doctor says i have nothing to worry about… is this normal? plz help, i can’t stand to lose anymore weight, from a size 34 to a size 28 in less than 12 months, im very worried.

  3. Simon Collins

    Hi Diana, I am not sure why you think we would say this? All drugs have the potential to cause side effects. Early HIV drugs certainly did cause lipoatrophy in many people. There is lots of information about this in this online guide:

    Luckily better drugs with fewer side effects are now generally used. It is difficult to comment on your situation now without knowing your treatment history and which meds you are taking now.

    What does your doctor say about these changes and how they affects you?

  4. Diana

    I can’t believe that you’re going to tell me these drugs don’t cause side effects I have had lipoatrophy and now I am fatter than I ever been having two daughters these drugs cause so many problems that they make quality of life in possible I’m even suicidal and extremely depressed caused by HIV drug side effects positive since 93

  5. Lisa Thorley

    Hi Vuyo,

    Its very unlikely that the belly fat is due to the meds. You haven’t been using them that long. Weight loss can be a complex thing, exercise and diet are key to this. If you’ve already lost some weight perhaps you just need some time.

  6. Vuyo


    I have started using TRENVIR since December 2018 when I was first diagnosed with HIV, however,I have been trying to lose belly fat, I even stopped drinking, I exercise and also eating less fat food to try and lose the belly, but I feel like I am failing to lose the belly fat, although I do realize that I have lost weight a bit… please advice….I am in South Africa

  7. Lisa Thorley

    Hi Lynn,

    Weight gain isn’t a common side effect with triumeq as the following discusses http://i-base.info/guides/10303 This is something to talk to your doctor about.

  8. Lynn A Trevains

    Take triumeq and gained 25 lbs, eating right and excersize and weight won’t come off. What HIV meds don’t cause weight gain

  9. Lisa Thorley

    Hi Grace,

    Body changes aren’t really common with modern day ARVs, so you should be OK. The best thing is to keep an eye on your weight.

  10. Grace

    I have been taking Tenofovir,lamivudine,for the past 4 yrs and because my viral load was still going up my Doc decided to change the drugs lamuvidine/zidovudine and Afazanavir/ritonavir,which is now too days,my quastion is will i now change the shape coz of new drugs?coz with the first drugs i didn’t change anything,
    I don’t want to change like cheen,bellys and other parts please help me.


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