4. 7 Metabolic changes: cholesterol, blood sugar, lipodystrophy

Metabolic changes refer to anything related to the way your body makes energy from the foods that you eat and drink. This includes the way your body processes and/or stores fats, carbohydrate (including sugar) and protein.

The risk of many common health problems are related to metabolic complication.

Changes in blood lipids (fats) like cholesterol and triglyceride levels are linked to heart disease.
Changes in blood glucose (sugar) can be an early sign of diabetes.

Routine monitoring by your HIV clinic, with blood or urine tests, look for these possible side effects.

Diet, exercise, changing treatment or using lipid-lowering or diabetes drugs can all help.

If you are worried, your doctor should take your concerns seriously and act on them.

Changes to cholesterol and other lipids

Raised levels of blood fats (lipids) has been reported with some HIV drugs.

There are two kinds of blood fat: cholesterols and triglycerides and these should be checked as part of routine monitoring on ART.

If these become high, then diet, exercise or lipid lowering drugs can usually reduce levels back to a normal range.

These are mainly linked to boosted protease inhibitors (darunavir, atazanavir and lopinavir) and switching to alternative drugs can also help.

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 metabolic symptoms.

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

Lipodystrophy

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

Lipodystrophy in not reported with modern HIV drugs.

It can still be a problem for people who started ART using early treatment, more tha 10, 15 or 20 years ago.

This is because these changes can cause serious psychological and social problems and because they did not reverse after changing to newer meds.

Doctors still do not know what caused lipodystrophy with early HIV drugs. 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.

4. 7 Metabolic changes: cholesterol, blood sugar, lipodystrophy

Changes to cholesterol and other lipids

Changes to blood sugars

Lipodystrophy

Further reading