• Lipodystrophy refers to changes in body fat and the metabolism of fat and sugar seen in people with HIV, mainly in people taking protease inhibitors and nucleoside analogues (NRTIs) together.

• d4T and to a lesser extent AZT have been associated with fat loss.

• Changing from d4T or AZT to abacavir or tenofovir can lead to a very slow improvement in fat loss. Exercise has been shown to improve central fat and metabolic problems.

• Facial fat loss may be improved by injections of a substance called polylactic acid. This is available on the NHS at some, but not all clinics.

• Cholesterol, triglyceride and glucose levels may rise after you start combination therapy. If you have existing heart disease, or several risk factors for heart disease, your doctor may suggest treatment to reduce these levels.

• The significance of metabolic changes in people without major risk factors for heart disease is still unknown.

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