LIPODYSTROPHY        Lipodystrophy was originally described as a condition characterized by regional or generalized loss of subcutaneous fat. The non-HIV-associated forms, such as congenital or familial partial lipodystrophy, have a very low prevalence. Generally, these forms are associated with complex metabolic abnormalities and are difficult to treat. The term "lipodystrophy syndrome" in association with HIV, was introduced to describe a complex medical condition including the apparent abnormal fat redistribution and metabolic disturbances seen in HIV-patients receiving protease inhibitor therapy (Carr et al. 1998). Since then, other conditions, such as osteopenia and hyperlactemia, have been summarized under the diagnosis of the lipodystrophy syndrome.        HIV-associated lipodystrophy includes both clinical and metabolic alterations. The most prominent clinical sign is a loss of subcutaneous fat (lipoatrophy) in the face (periorbital, temporal), limbs, and buttocks. Prospective studies have demonstrated an initial increase in limb fat during the first months of therapy, followed by a progressive decline over the ensuing years (Mallon et al. 2003). Peripheral fat loss can be accompanied by an accumulation of visceral fat which can cause mild gastrointestinal symptoms. Truncal fat increases initially after therapy and then remains stable (Mallon et al. 2003). Visceral obesity, as a singular feature of abnormal fat redistribution, appears to occur in only a minority of patients. Fat accumulation may also be found as dorsocervical fat pads ("buffalo hump") within the muscle and the liver. Female HIV patients sometimes complain about painful breast enlargement which has been attributed to the lipodystrophy syndrome. Whether gynecomastia in male patients is a component of the syndrome remains unclear. There is now accumulating evidence that the major clinical components - lipoatrophy, central adiposity and the combination of both - result from different pathogenetic developmental processes. The prevalence of lipodystrophy syndrome has been estimated to be between 30 and 50% based on cross-sectional studies.        People infected with HIV/AIDS are living longer and more productive lives. A large part of the reason is the introduction of medication combinations into standard HIV/AIDS care. But with the benefits of medications also comes some unforeseen problems. One such problem is fat redistribution syndrome or lipodystrophy.        Usually fat redistribution is not physically harmful to the person, although it can cause emotional consequences related to altered self image and appearance. Patients fear the physical manifestations of fat redistribution give them what is known as the "AIDS look". In some cases however, fat build-up in the neck and back of the head ("buffalo hump"), cause physical harm such as difficulty breathing, neck and back pain and headaches. So the question is what can be done? There are a few choices that have some positive effects: Switching therapies to non-protease inhibitor combos stopping protease inhibitors is sometimes effective long-term effectiveness not proven some lipodystrophy develops in the absence of protease inhibitors or returns after the PI has been d/c'd sometimes lipodystrophy persists even after stopping drugs protease inhibitor not proven conclusively to be the cause of lipodystrophy consult your doctor before stopping any of your medications Diet and exercise some success has been seen in people with lower lipid levels as a result of eating a low-fat diet low-fat diets are healthier even in the absence of lipodystrophy consult a nutritionist or dietician for the best results Lipid-lowering drugs "statin" type drugs are effective in lowering blood levels of triglycerides and cholesterol can be somewhat effective in the presence of lipodystrophy high levels of triglycerides and cholesterol increase the risk of heart and vascular disease caution must be used when prescribing lipid lowering drugs while taking HIV medications. Hormonal therapy some researchers believe hormonal therapy with drugs such as Serostim and testosterone may be helpful in controlling body-shape changes in lipodystrophy. Serostim and testosterone has been shown to build muscle mass neither drug will help lower lipid levels in the blood and both present their own set of side effects.
What Is AIDS Wasting? AIDS wasting is the involuntary loss of more than 10% of body weight, plus more than 30 days of either diarrhea, or weakness and fever. Wasting is linked to disease progression and death. Losing just 5% of body weight can have the same negative effects. Wasting is still a problem for people with AIDS. Part of the weight lost during wasting is fat. More important is the loss of muscle mass. This is also called "lean body mass," or "body cell mass." AIDS wasting and lipodystrophy both can cause some body shape changes.  Wasting is the loss of muscle. Lipodystrophy is a loss of fat. What Causes AIDS Wasting? Several factors contribute to AIDS wasting syndrome: Low food intake: Low appetite is common with HIV. Also, some AIDS drugs have to be taken with an empty stomach, or with a meal. This can make it difficult for some people with AIDS to eat when they're hungry. Drug side effects such as nausea, changes in the sense of taste, or tingling around the mouth also decrease appetite. Opportunistic infections in the mouth or throat can make it painful to eat. Infections in the gut can make people feel full after eating just a little food. Finally, lack of money or energy may make it difficult to shop for food or prepare meals. Poor nutrient absorption: Healthy people absorb nutrients through the small intestine. In people with HIV disease, several infections (including parasites) interfere with this process. HIV may directly affect the intestinal lining and reduce nutrient absorption. Diarrhea, a frequent side effect of AIDS drugs, causes loss of calories and nutrients. Altered metabolism: Food processing and protein building are affected by HIV disease. Even before any symptoms show up, energy output is increased. This might be caused by the increased activity of the immune system. People with HIV need more calories just to maintain their body weight. Hormone levels can affect the metabolism. HIV seems to change some hormone levels. Also, cytokines play a role in wasting. Cytokines are proteins that produce inflammation to help the body fight infections. People with HIV have very high levels of cytokines. This makes the body produce more fats and sugars, but less protein. Unfortunately, these factors can work together to create a "downward spiral." For example, infections may increase the body's energy requirements. At the same time, they can interfere with nutrient absorption and cause fatigue. This can reduce appetite and make people less able to shop for or cook their meals. They eat less, which accelerates the process. How Is Wasting Treated? There is no standard treatment for AIDS wasting. Treatments for wasting syndrome address each of the causes mentioned above. Reducing nausea and vomiting helps increase food intake. AIDS activists have long urged the legalization of marijuana. It reduces nausea and stimulates the appetite. In the late 1990s, several states legalized the medical use of marijuana. Treating diarrhea and opportunistic infections in the intestines helps alleviate poor nutrient absorption. There has been a lot of progress in this area. However, two parasitic infections -- cryptosporidiosis and microsporidiosis -- are still extremely difficult to treat. Another approach is nutritional supplements like Ensure® . These have been specifically designed to provide easy-to-absorb nutrients. They have not been carefully studied yet. Treating changes in metabolism: Hormone treatments are being examined. Human growth hormone increases weight and lean body mass, while decreasing fat mass. Testosterone and anabolic (muscle building) steroids might also help treat wasting. They are being studied alone and in combination with exercise. Also, thalidomide seems to reverse weight loss due to its ability to reduce levels of cytokines.