Lipodystrophy syndrome(s)

November 2001     View PDF     En español

What causes lipodystrophy?

There has been much debate over what causes lipodystrophy in people living with HIV. Some researchers have proposed that it’s due to direct effects of the protease inhibitors, and it certainly has become more common since they were made available. Others say that some of the nucleoside analogue drugs may be a contributing factor, and these drugs have indeed been more widely used and used for longer times since the advent of the protease inhibitors.

Some researchers report seeing lipodystrophy when using only two-drug nucleoside analogue combinations. Some speculate that it may be caused by rapid and sustained decreases in viral load (HIV RNA levels). This may not be unique to a particular class of anti-HIV drugs but related only to the potency of the total regimen, with the most potent regimens posing the greatest risk. It may also be caused by HIV itself interfering with how the body processes fats.

Some manifestations of lipodystrophy, like wasting in the face, arms, and legs, have been common since the earliest days of the epidemic. Or, it may even be due to the immune system becoming more aggressive once the onslaught of HIV is slowed down in response to therapy. Finally, it may be due to a combination, or different combinations, of these factors.

In a study by Dr. Kotler, a specialist in HIV-associated wasting, body shape information was collected from people since 1996 and compared to information gathered before the availability of protease inhibitors. This study confirmed that loss of weight, body cell mass and fat, and changes in body fat are characteristic features of HIV infection, and not strictly related to protease inhibitors. Reports of central obesity preceded the protease inhibitor era. These reports were similar in both men and women and in volunteers both taking and not taking protease inhibitors.