• Most research shows that the longer you take anti-HIV treatment, the more likely you are to have changes in your body fat. Studies have shown that after three years on a combination of nucleoside analogues and a protease inhibitor, 30 to 40% of people will develop body fat changes. It is not yet clear whether the risk carries on growing after this point, or whether most people who will eventually get lipodystrophy can expect to do so within three years of starting treatment with a protease inhibitor and NRTIs.

• People who are overweight are more likely to complain of an increase in central fat.

• Fat loss is more commonly reported in men than women, although women with average or low body weight are more likely to observe loss of fat than women who are overweight.

• Older people are more likely to report both central fat gain and fat loss from the arms, legs and face. It may be that some of these changes are being confused with the usual body fat changes that occur with ageing – because the syndrome is new it will take time to be sure.

• The extent of immune system damage before starting and the recovery after treatment also seems to influence the risk of body fat changes. A large CD4 cell rise and a past CD4 cell count below 200 have been associated with more severe fat loss (but these may be an indication of very successful treatment or the length of time you have been on treatment, both of which have been suggested as causes of the body fat changes. See Combination therapy and body fat changes on page x).

• Body fat changes have been less common in children, but tend to become more noticeable in teenagers.

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