Our first weapon against the extreme makeover known as lipodystrophy? Knowledge. Two recent large studies—from Spain and Colorado—question using “lipodystrophy” as a blanket term for both the fat deposits and fat wasting that HIVers experience. And the University of Colorado’s Kenneth Lichtenstein, MD, who reviewed 17 studies of the lipo syndrome, found that fat loss was linked to certain nukes—but not protease inhibitors (PIs). By contrast, fat accumulation was tied to PIs—but not nukes.

The takeaway? By tailoring drugs and making lifestyle changes, we could soon be living lipo-free.

Reversing fat loss
David Cooper, MD, the Australian professor who coined the term “lipodystrophy,” says the days of gaunt Grim Reaper faces are numbered. “We now know the drugs to avoid if you can,” he says: Zerit (d4T) and Retrovir (AZT)—which is also in Combivir (with Epivir [3TC]) and Trizivir (with Epivir and Ziagen [abacavir]).

In one study, people regained a third of lost limb fat 16 months after switching from Zerit or AZT to Ziagen. In another, HIVers who changed from Zerit or AZT to Ziagen or Viread (tenofovir) slowly became cheeky again.

Can’t wait? Some HIVers swear by the face filler Sculptra. HIVer Bernard Forbes, of the UK Coalition of People Living With HIV and AIDS, has had repeated injections. But his fat loss continued outside the treated areas, giving him a “lumpy face” look. He’s now trying a switch from Combivir to a PI-based combo.

Trimming fat gain
The potbelly is more problematic. Using human growth hormone (HGH or Serostim) is expensive, only works as long as you take it and has side effects.

Andrew Little, of London’s Ensuring Positive Futures, says: “My left arm turned into an amazing muscular Popeye arm, and I thought, ‘If this continues, I’ll be hot stuff!’ But I had to stop, literally due to growing pains—terrible aches in the joints.”

Drugs that alleviate blood-sugar problems (linked to fat accumulation) don’t fix the body-shape changes. So UK AIDS doc Mike Youle, MD, says, “What works? Exercise and a good diet.” A buff physique can camouflage that belly. And, as Youle says: “Genes count, but people who get diabetes are often those who sit around eating chips and chocolate.” Get up and boogie.

How to fight back

  • Ask your doctor about using the newer nukes Ziagen (also combined with Epivir in Epzicom) or Viread (also combined with Emtriva [FTC] in Truvada).
  • Use that gym membership!
  • Eat a diet high in protein and unprocessed carbs and low in fat and sugar. n For a PI, try Reyataz (atazanavir), which causes the least blood-fat increases.
  • Face fillers like Sculptra and the (unlicensed) Bio-alcamid are good stopgap measures when you’ve lost face fat.
  • Statins (for high cholesterol) help with high fat in the blood but won’t correct body shape (diabetes drugs like rosiglitazone drop blood sugar and fat, too).
  • Hormones (HGH and testosterone) can help reduce abdominal fat but have other side effects.
  • The supplement l-acetyl carnitine (LAC) can reduce blood cholesterol and neuropathy. Ongoing studies will tell if it helps fat wasting.    

More Lipo Lickers
A small Dutch study has found that diabetes drugs rosiglitazone and metformin can help HIVers who’ve lost or gained fat on HIV meds. Unlike previous studies, it found that rosiglitazone restored fat for some HIVers (those with mild insulin resistance); metformin decreased deep abdominal fat. About half on rosiglitazone and a quarter on metformin said they perceived less lipo. (Folks with kidney or liver disease were excluded.)