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Preventing physical wasting and weight loss is an important aspect of HIV/Aids treatment among people who aren’t on ARVs. But other factors come into play for those who are.
In the late 1990s, researchers studying people with HIV/Aids discovered that certain complex metabolic changes occurred in individuals on antiretroviral (ARV) therapy. In particular, researchers became aware that these people experienced a redistribution of their fat stores and tended to develop raised blood fat levels and raised cholesterol levels.
Lipodystrophy refers to the syndrome of abnormal fat distribution which includes both lipohypertrophy (fat accumulation) and lipoatrophy (fat wasting or loss).
Lipodystrophy has been linked to particular classes of drugs known as protease inhibitors, which have been connected to fat, as well as nucleoside reverse transcriptase inhibitors, which have been linked with lipoatrophy (fat loss from limbs, face and buttocks).
Lipodystrophy and lipoatrophy
One of the most characteristic features of this change in metabolic requirements is lipodystrophy, which includes wasting of the limbs and redistribution of fat into the abdominal area.
Lipoatrophy refers to the loss of fat from the face and other areas of the body. In moderate and severe cases lipoatrophy of the face appears as “sunken cheeks”. While this emaciated appearance may not be a concern medically, it has been shown to have a psychological impact on sufferers such as:
• Feelings of low self-esteem
• Depression
• Relationship problems
• Fear of stigmatisation
It’s estimated around 20% of people with HIV will experience this, with women more prone to it than men. While fat accumulation often appears sooner than fat loss, both appear fairly slowly.
Despite the fact that the physical changes associated with lipodystrophy often cause much psychological distress, the changes are accompanied by metabolic changes in the way the body processes sugars and fats, which can cause an increase in the risk of cardiovascular disease, particularly in women.
Other metabolic features
In addition to the redistribution of fat in the body, researchers have also found that HIV patients receiving ARV therapy may have other metabolic changes, such as:
• Increased insulin levels
• Insulin resistance
• Increased free fatty acid concentrations
• Reduced glucose tolerance and hyperglycaemia
• Increased triglyceride levels
• Increased levels of other blood fats (LDL-cholesterol and total cholesterol)
Solutions
Changing medications: If you suffer from lipodystrophy your first step in managing it should be to alter your HIV drugs. Your doctor or healthcare advisor will be able to assist you in making the right choice, which will be based on a number of factors such as:
• Your HIV drug history.
• Previous resistance or intolerance to certain ARVs.
Some research points to the fact that changing to a protease inhibitor-sparing regimen can, in some cases, reverse some of the metabolic disorders associated with lipohypertrophy.
Lowering lipids: In some instances a person may be given medication to reduce lipids to lower the harmful levels of fats in the blood, often given in conjunction with protease inhibitors.
Healthy living: Maintaining a healthy diet which is in particular lower in “bad” cholesterol and higher in “good” cholesterol, together with regular exercise have also been shown to have a positive effect, though research has shown that this alone is not enough to show massive improvements in body shape associated with lipodystrophy changes.
The importance of diet
People who may have developed fat redistribution and raised blood insulin and fat levels need to be treated with diets that combine the principles used for insulin resistance and hyperlipidaemia.
Insulin resistance is treated with a diet that has a low glycaemic index (GI) and a low glycaemic load (GL). This type of diet makes use of foods that have a low GI.
Hyperlipidaemia, or raised blood fat levels, is treated with a diet that is low in total fat, saturated fat and cholesterol, but still includes the “good” fats such as monounsaturated and polyunsaturated fats and oils.
In other words, a person with HIV who is receiving ARV therapy and has developed any one of the above-mentioned changes in metabolism needs a diet that combines the principles of low GI and low fat.
A clinical dietician should be consulted to work out a diet based on the principles of low GI and low fat and cholesterol, but still contains sufficient energy to prevent wasting due to the viral infection and provides the protective nutrients you require to boost your immune system.
Each person needs an individual diet because he or she has unique requirements. One person may react to certain foods (e.g. milk), while another may have increased needs for vitamins and minerals.
Many factors play a role in the dietary treatment of HIV/Aids, for example diarrhoea or infections of the mouth and throat may make food intake difficult. This is the reason why you need to consult a dietician to work out a specific and individual diet.
HIV/Aids is a complex problem but, with the correct diet and treatment, you can improve your quality of life and combat this dreaded disease.
In the late 1990s, researchers studying people with HIV/Aids discovered that certain complex metabolic changes occurred in individuals on antiretroviral (ARV) therapy. In particular, researchers became aware that these people experienced a redistribution of their fat stores and tended to develop raised blood fat levels and raised cholesterol levels.
Lipodystrophy refers to the syndrome of abnormal fat distribution which includes both lipohypertrophy (fat accumulation) and lipoatrophy (fat wasting or loss).
Lipodystrophy has been linked to particular classes of drugs known as protease inhibitors, which have been connected to fat, as well as nucleoside reverse transcriptase inhibitors, which have been linked with lipoatrophy (fat loss from limbs, face and buttocks).
Lipodystrophy and lipoatrophy
One of the most characteristic features of this change in metabolic requirements is lipodystrophy, which includes wasting of the limbs and redistribution of fat into the abdominal area.
Lipoatrophy refers to the loss of fat from the face and other areas of the body. In moderate and severe cases lipoatrophy of the face appears as “sunken cheeks”. While this emaciated appearance may not be a concern medically, it has been shown to have a psychological impact on sufferers such as:
• Feelings of low self-esteem
• Depression
• Relationship problems
• Fear of stigmatisation
It’s estimated around 20% of people with HIV will experience this, with women more prone to it than men. While fat accumulation often appears sooner than fat loss, both appear fairly slowly.
Despite the fact that the physical changes associated with lipodystrophy often cause much psychological distress, the changes are accompanied by metabolic changes in the way the body processes sugars and fats, which can cause an increase in the risk of cardiovascular disease, particularly in women.
Other metabolic features
In addition to the redistribution of fat in the body, researchers have also found that HIV patients receiving ARV therapy may have other metabolic changes, such as:
• Increased insulin levels
• Insulin resistance
• Increased free fatty acid concentrations
• Reduced glucose tolerance and hyperglycaemia
• Increased triglyceride levels
• Increased levels of other blood fats (LDL-cholesterol and total cholesterol)
Solutions
Changing medications: If you suffer from lipodystrophy your first step in managing it should be to alter your HIV drugs. Your doctor or healthcare advisor will be able to assist you in making the right choice, which will be based on a number of factors such as:
• Your HIV drug history.
• Previous resistance or intolerance to certain ARVs.
Some research points to the fact that changing to a protease inhibitor-sparing regimen can, in some cases, reverse some of the metabolic disorders associated with lipohypertrophy.
Lowering lipids: In some instances a person may be given medication to reduce lipids to lower the harmful levels of fats in the blood, often given in conjunction with protease inhibitors.
Healthy living: Maintaining a healthy diet which is in particular lower in “bad” cholesterol and higher in “good” cholesterol, together with regular exercise have also been shown to have a positive effect, though research has shown that this alone is not enough to show massive improvements in body shape associated with lipodystrophy changes.
The importance of diet
People who may have developed fat redistribution and raised blood insulin and fat levels need to be treated with diets that combine the principles used for insulin resistance and hyperlipidaemia.
Insulin resistance is treated with a diet that has a low glycaemic index (GI) and a low glycaemic load (GL). This type of diet makes use of foods that have a low GI.
Hyperlipidaemia, or raised blood fat levels, is treated with a diet that is low in total fat, saturated fat and cholesterol, but still includes the “good” fats such as monounsaturated and polyunsaturated fats and oils.
In other words, a person with HIV who is receiving ARV therapy and has developed any one of the above-mentioned changes in metabolism needs a diet that combines the principles of low GI and low fat.
A clinical dietician should be consulted to work out a diet based on the principles of low GI and low fat and cholesterol, but still contains sufficient energy to prevent wasting due to the viral infection and provides the protective nutrients you require to boost your immune system.
Each person needs an individual diet because he or she has unique requirements. One person may react to certain foods (e.g. milk), while another may have increased needs for vitamins and minerals.
Many factors play a role in the dietary treatment of HIV/Aids, for example diarrhoea or infections of the mouth and throat may make food intake difficult. This is the reason why you need to consult a dietician to work out a specific and individual diet.
HIV/Aids is a complex problem but, with the correct diet and treatment, you can improve your quality of life and combat this dreaded disease.
