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Changing treatment due to lipodystrophy
Lipodystrophy is the name given to a syndrome of side-effects caused by anti-HIV drugs. It includes an increase in fats in the blood (which can increase your long-term risk of a heart attack, diabetes and stroke), and changes in body shape (including fat loss from the face, limbs and buttocks), and fat gain (at the back of the neck – sometimes called buffalo hump – and around the stomach).
The NRTI d4T has been particularly associated with fat loss, and if you are taking d4T you are recommended to switch it for another drug, if you have treatment options available.
If you have high blood fats and are taking a protease inhibitor, then it might be worth switching to an NNRTI, if this option is available to you. Changes in your diet can also help, see the chapter Nutrition and HIV . Exercise can also be helpful and is looked at in more detail in the chapter Exercise . Your doctor can also prescribe drugs (called statins and fibrates) to control fats in your blood.
Changing your treatment appears to have only a very minimal impact on body fat changes. Lost fat has been shown to slowly return to the limbs for two years after switching from d4T to abacavir. Fat loss can be very distressing, particularly fat loss from the face. The use of a cosmetic treatment called New Fill (polylactic acid) can help fill out the checks and remedy the wasted appearance that facial fat loss causes. Treatment involves a course of injections, and it may have to be repeated. Some, but not all, HIV clinics provide the treatment for free on the NHS, but some people have to obtain New Fill treatment privately. A single course of treatment costs from £800 – £1,200.
Surgery is sometimes used to remove fat which has accumulated around the back of the neck.
Fat loss and fat gain caused by anti-HIV drugs can be emotionally very distressing and uncomfortable. It’s important that you let your doctor know how body fat changes are affecting you. If you have fat loss from the face or fat gain around the neck, your doctor may be able to refer you for cosmetic surgery to help correct it. Staff at hospitals with large HIV clinics are becoming very skilled at providing cosmetic treatments for fat loss and fat gain caused by anti-HIV drugs. Also make sure that you tell your doctor if changes in your body shape are causing emotional or psychological problems, as mental health support will be available.