At the moment there is no treatment that will reverse all the body fat changes. Some people who stop treatment altogether report improvements, but may not return to normal, and most people with body fat changes are not in a position to stop taking anti-HIV drugs.

Dietary changes have not been shown to improve body fat changes, so eating less fat is not likely to help (although it may help reduce cholesterol levels). See page xx for further advice on diet and managing lipid levels.

Human growth hormone

Fat deposits on the abdomen and between the shoulder blades may be reduced by taking human growth hormone, but you have to keep taking human growth hormone for the improvement to last, and the correct dose is not known. Side-effects such as joint pain and swelling in the hands and feet are common, and the development of diabetes has been reported in a small number of people with lipodystrophy who received this treatment.

Anabolic steroids

Anabolic steroids have been suggested by some people as a treatment for body fat changes because gains in abdominal fat in older men have been linked to declining testosterone levels. Anabolic steroids encourage the growth of muscle tissue at the cost of subcutaneous fat and so may increase the rate of fat loss from the face and limbs. Anabolic steroids may also cause further increases in cholesterol levels and could harm the liver. Various anabolic steroids are being tested in clinical trials for weight loss at the moment.

Metformin

A drug used to treat diabetes, called metformin, may be effective in reducing abdominal fat deposits. It also reduces triglyceride levels and improves glucose metabolism. Metformin often triggers some weight loss and so it may not be suitable for people with fat loss. It may cause nausea and diarrhoea and requires monitoring for lactic acidosis. Metformin is available only through specialists in diabetes.