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LipodystrophySide Effects of Anti-HIV Medications — Lipodystrophy A Service of the U.S. Department
of Health and Human Services
What is lipodystrophy?
Terms Used in This Fact Sheet:
Lipodystrophy, also called fat redistribution, is a Baseline: an initial measurement made before starting
disturbance in the way your body produces, uses, and therapy and used as a reference point. stores fat. There are two different kinds of lipodystrophy. Metabolic: referring to the buildup or breakdown of the
In fat wasting, also known as lipoatrophy, fat is lost body's molecular building blocks. These building blocks from particular areas of the body, especially the arms, provide the material and energy that your body needs to function. legs, face, and buttocks. The second kind of lipodystrophy is fat accumulation, also known as hyperadiposity. In Magnetic resonance imaging (MRI): a way to take
pictures of the inside of the body. MRI uses magnetic fields
fat accumulation, fat builds up in particular parts of the and radio waves instead of x-rays. MRIs are particularly body, especially the belly, breasts, and back of the neck. useful for taking pictures of the body's soft tissues and organs. What does lipodystrophy look like?
Non-nucleoside reverse transcriptase inhibitor (NNRTI):
class of anti-HIV medication. NNRTIs work by blocking
reverse transcriptase, a protein that HIV needs to make • back of the neck and upper shoulders copies of itself. The NNRTIs approved by the FDA are Rescriptor, Sustiva, and Viramune. (often described as "buffalo hump") Nucleoside reverse transcriptase inhibitor (NRTI): class of
• abdomen (also called "protease paunch" anti-HIV medication. NRTIs are faulty versions of the building blocks (nucleosides) used by reverse transcriptase, a protein that HIV needs to make copies of • lipomas (fatty growths in different parts of the body) itself. The NRTIs approved by the FDA are Combivir, Emtriva, Epivir, Epzicom, Retrovir, Trizivir, Truvada, Videx, Viread, Zerit, and Ziagen. Protease inhibitor (PI): class of anti-HIV medication. PIs
• face (sunken cheeks, temples, and eyes) work by blocking protease, a protein that HIV needs to • arms and legs (veins may become more visible; make copies of itself. The PIs approved by the FDA are Agenerase, Aptivus, Crixivan, Fortovase, Invirase, Kaletra, Lexiva, Norvir, Reyataz, and Viracept. Are there any other disorders that occur
What causes lipodystrophy?
along with lipodystrophy?
Early studies suggested that lipodystrophy was If you have lipodystrophy, you may also have other associated with the use of protease inhibitors (PIs),
a class of commonly prescribed anti-HIV drugs. However, other studies have shown that lipodystrophy also occurs in people who have never taken PIs. Evidence now suggests that lipodystrophy is linked to taking nucleoside reverse transcriptase inhibitors
and insulin resistance is called lipodystrophy syndrome. (NRTIs) and PIs at the same time.
of Antiretroviral Agents in HIV-Infected Adults and Adolescents Side Effects of Anti-HIV Medications — Lipodystrophy A Service of the U.S. Department
of Health and Human Services
Other risk factors for lipodystrophy include: • age—older people are at higher risk for lipodystrophy How is lipodystrophy treated?
• race—whites are at higher risk for lipodystrophy At this time, there are no clearly effective treatments for lipodystrophy. However, if you have lipodystrophy, you sex—men are more likely to experience fat loss in their arms and legs, while women tend to have an • Changes to your anti-HIV medications—People with lipodystrophy may benefit from changes to their HIV • length and severity of HIV infection—the longer you treatment regimens. If you are taking Zerit, switching have been infected and the more severe your to Ziagen (abacavir, ABC) may help reduce infection, the higher your risk for lipodystrophy lipodystrophy. PIs may be replaced with non-
• a baseline body mass index (BMI) in the obese range
nucleoside reverse transcriptase inhibitors
or significant weight changes are risk factors for (NNRTIs), which do not appear to cause
lipodystrophy. However, the results of switching drugs • baseline immune system health and how well your are uncertain; you and your doctor may decide that immune system recovered after starting anti-HIV changing medications is not right for you. Be sure to talk with your doctor before stopping or switching any medications. • Diet and exercise— Changes to your diet and exercise Which anti-HIV drugs are most likely to
regimen may help build muscle and reduce fat cause lipodystrophy?
Zerit (stavudine, d4T) is one NRTI that has been • Medications—If you have insulin resistance and are specifically shown to cause fat loss. PIs may increase the risk of fat accumulation. The longer you take NRTIs and PIs, the greater your chance of developing • Injections, implants, and surgery—If you have fat wasting, you may benefit from injections of human growth hormone (hGH) to boost muscle size in your How will my doctor and I know if I have
arms and legs. Injections of fat or synthetic fat lipodystrophy?
substitutes like Sculptra can fill out sunken cheeks, as can cosmetic cheek implants. However, most of these A diagnosis of lipodystrophy is usually made by treatments, along with surgery to remove fat examining your body for fat changes. Your doctor may accumulation, are still being studied and do not yet measure around your arms, thighs, waist, hips, and neck have FDA approval for the treatment of HIV-related before you start medication and then periodically lipodystrophy. Sculptra is the only treatment that is throughout your treatment. Abdominal magnetic
resonance imaging (MRI)
currently approved; it received FDA approval in abdominal fat; however, there are currently no specific recommendations for routine assessment and monitoring of lipodystrophy. For more information:
of Antiretroviral Agents in HIV-Infected Adults and Adolescents
LIST OF PUBLICATIONS REFERRED TO IN THE 23RD EDITION (2012 – 2013) OF THE BELGIUM – LUXEMBOURG VERSION OF THE SANFORDGUIDE TO ANTIMICROBIAL THERAPY TABLE 14D PARASITIC INFECTIONS: TREATMENT OF INFECTIONS DUE TO CESTODES Walker MD, Zunt JR. Neuroparasitic infections: cestodes, trematodes and protozoan García HH (Cysticercosis Working Group in Peru). Neurocysticercosis i