Lipodystrophy syndrome(s)

November 2001     View PDF     En español

Treating symptoms

Since the cause is uncertain, treating lipodystrophy is an inexact science and tries to deal mostly with the changes in body appearance and blood work. Some possible ways to manage lipodystrophy are explained below.

Switch therapy
Switching to a new anti-HIV therapy or stopping therapy altogether might be a useful, although unproven, approach to stop these changes. Studies of this approach have shown conflicting results. Again, it’s important to remember that changes in body shape have been seen in people on no therapy and in people on one-, two-, and three-drug regimens. If anti-HIV therapy causes body shape changes in your case, then switching off the offending drug(s) might stop these changes.

However, if lipodystrophy seems associated with a protease inhibitor, try a different one or switch it with a NNRTI. Three separate reports claim some success in switching people to a NNRTI. Doctors report some decrease in central obesity; however, not everyone had a return of fat in the arms and legs. Lower cholesterol and triglyceride levels and a reversal of insulin resistance were also reported.

A Sydney group has conducted a great deal of lipodystrophy research on a study of 80 people who either continued using protease inhibitors or switched to a regimen of abacavir + adefovir + nevirapine + hydroxyurea. People who switched had decreases in triglyceride and cholesterol levels but no change in HDL or good cholesterol. Also, those who switched had some reduction in abdominal fat but continued to lose peripheral fat from their arms and legs. They also lost, on average, about six pounds. It’s not clear whether the weight loss is due to switching anti-HIV drugs or other factors. (Several studies report that people on adefovir lose weight.) People who continued using protease inhibitors continued to gain abdominal fat.

A Barcelona study followed 106 people who used therapy that included protease inhibitors or switched to ddI+d4T+nevirapine. Those who switched significantly lowered their cholesterol and triglyceride levels while those who continued on protease inhibitors saw no change in either measurement. Neither group had changes in glucose levels. The loss of peripheral fat seemed to stabilize among people who switched while those on protease inhibitors continued to lose peripheral fat. There were no significant reductions in abdominal fat in either group. There were also no differences in viral load rebounds (from below to above 50 copies HIV RNA) between the two groups after 36 weeks. Those switching therapy had a small increase in CD4+ cell counts.

These and other results suggest that protease inhibitors are primarily responsible for the reported increases in triglyceride and cholesterol levels. Switching to a regimen without protease inhibitors does appear to lower these levels. However, it’s unclear whether this is true for all non-protease inhibitor drugs. For instance, several studies have shown that the non-nucleoside, efavirenz, also increases these levels.

Changing therapy may or may not reverse fat redistribution. It is entirely possible that some side effects are due to specific drugs but not whole drug classes. In other words, one protease inhibitor may increase these levels while another may not. Some newer results support this theory.

For example, based on some relatively short-term studies, amprenavir does not appear to increase triglycerides and cholesterol as much as other currently available protease inhibitors. Other studies suggest that d4T affects peripheral fat loss more than other nucleoside analogue drugs. Two studies show that people who switched from d4T to other nucleoside analogues had increases in peripheral fat but no change in abdominal fat. These observations suggest that some fat redistribution may be reversible.

Liposuction/plastic surgery
Liposuction is surgery that is almost literally a vacuuming out of fat. Some people with a buffalo hump have had liposuction to remove it. Likewise, some men and women with breast enlargement have had breast reduction surgery. Treating central obesity with liposuction has generally been discouraged since the fat deposits are difficult to reach and not well suited to liposuction.

These surgeries are not without risk and anecdotal reports of success have been varied. Some claim that surgery resulted in a long-lasting resolution while others report that the hump just “grew back” over time.

Human growth hormone (Serostim)
Unconfirmed reports from a physician in New York claim that treating with human growth hormone (HGH) therapy reduced buffalo humps and central obesity. The physician, Dr. Torres, presented photos of patients with severe body shape changes showing improvement after therapy with HGH. Dr. Torres notes that when HGH therapy was stopped, buffalo humps and central obesity returned. He further noted that HGH therapy had no impact on treating facial or limb wasting. However, the number of treated patients was very small, and the study was not controlled by a comparison group. Studies are now ongoing to formally study HGH for treating these symptoms.