|Body Shape Changes|
People who are taking HIV medicines and living longer sometimes experience visible changes in body shape and appearance. This condition is called lipodystrophy (pronounced "li-po-dis-tro-fee"). "Lipo" means fat, "dystrophy" means abnormal growth or change. So, lipodystrophy means abnormal changes in fat. These changes can be caused by HIV itself or by HIV medications.
These changes were much more common with older HIV medications. Current HIV medicines are much less likely to cause body changes and many people experience no body changes at all.
Possible changes in body appearance:
| Types of fat|
Lipodystrophy involves two types of fat in the body. One type, called visceral fat, lines internal organs. Too much visceral fat can put a person at risk of a heart attack, stroke, or diabetes.
The other type, called subcutaneous fat, is right under the skin. This fat can be lost in HIV, leading to prominent veins in the arms and legs and changes in facial appearance. Loss of subcutaneous fat is not life threatening but can have serious effects on the way people see themselves. It can lead to depression, anxiety, and low self-esteem.
| Fat around neck, shoulders, breasts, and face|
Another change is fat buildup on the back of the shoulders and neck (sometimes called a "buffalo hump"). Fat on the back of the neck doesn't raise the risk of heart disease but can cause headaches and sometimes problems with breathing and sleeping.
Fat gain can make breasts bigger, which can cause back pain. Women seem more likely than men to experience greater fat gain in the breasts and the abdomen.
Fat accumulation also can make the face appear fuller.
| Fatty bumps on the body|
Little fatty bumps called lipomas can appear under the skin anywhere on the body.
| Fat loss in the face, legs, or arms|
Some people lose fat, usually from the face, arms, legs, or buttocks. Cheeks may appear sunken. Muscles and veins in the legs may look bigger because there is less fat to hide them.
This fat loss is from the subcutaneous fat found just underneath the skin. These changes can affect a person's self-esteem, and can lead to depression and anxiety.
| What can you do?|
Experts aren't sure whether these changes are due to HIV itself, or to the anti-HIV drugs. There are no proven cures at this time, but there are steps you can take to reduce the effects.
Plastic surgeons can use liposuction (sucking out the fat) on a buffalo hump. Liposuction, however, is not a good treatment for fat around the gut because of possible damage to the organs.
For fat loss in the face, doctors can inject fat or a fat-like substance to fill out sunken cheeks or other areas, such as around the eyes and mouth. In 2004, the U.S. Food and Drug Administration approved the use of Sculptra, an injectable product that can replace fat lost from the face.
If you are experiencing any of these changes, be sure to talk to your health provider about them. Finding a solution to these body shape changes is a major research effort, and new therapies may become available in the future.
| Figure 1. Fat accumulation around neck ("Buffalo Hump")|