Lipodystrophy is a condition which causes changes in body shape and involves fat loss or fat gain in certain parts of the body.

Long-term use of some older anti-HIV drugs is associated with lipodystrophy but these drugs –  stavudine (Zerit) and zidovudine (Retrovir), which is also included in pills called Combivir and Trizivir – are now avoided as much as possible. You can find out more about this in the NAM booklet, Side-effects.

Some people do find that they gain weight after starting HIV treatment but this is more likely due to improved health or eating too much and not doing enough exercise. A combination of resistance training and aerobic exercise can help with body shape. Aerobic exercise improves your heart’s ability to pump and your muscles’ ability to use oxygen.

Resistance training builds muscles which burn triglycerides stored in body fat. Activities like yoga and swimming do provide some resistance, but the most efficient way is to use free weights or weight machines in a gym. Working on large muscle groups brings the most benefit. To improve muscle strength you need to load your muscles quite heavily. Therefore it’s a good idea to do a warm-up using a light weight and then do a small number of repetitions using relatively heavy weights.

It’s a good idea to seek advice on using weights before you begin. If you use a gym there should be staff available who can advise you and help you to plan your training. Your training weight needs to be increased as your strength increases to make sure your muscles continue to experience resistance.

Untreated HIV can increase the risk of cardiovascular (heart) disease. Other risk factors include having a family history of heart disease, being overweight, or being a smoker. The risk of heart disease and other serious illnesses is reduced by starting HIV treatment.

But treatment with some anti-HIV drugs, particularly drugs in the protease inhibitor class and older drugs of the NRTI class that are rarely used today, has been linked to metabolic changes that can increase the long-term risk of cardiovascular disease. Lipodystrophy, gaining too much weight after starting HIV medicines, and the length of time you have been living with HIV can also increase this risk.

Your heart can be damaged if you are overweight, or by eating too much of certain foods, such as saturated fats. These can raise your cholesterol levels and clog the arteries that supply the heart with blood, restricting the blood supply to the heart. This damage can lead to heart conditions such as angina (a syndrome which causes chest pains) and eventually to heart attack.  

Smoking, lack of exercise, drug use and heavy drinking can also contribute to cardiovascular disease.

Eating a balanced, healthy diet and taking regular exercise can reduce the effect of treatment-related metabolic changes and of developing cardiovascular disease.

People living with HIV have a higher risk of developing diabetes, a condition where the amount of glucose (a type of sugar) in the blood is too high because the body cannot use it properly.

Type 1 diabetes usually occurs earlier in life. This happens when the body is unable to produce enough insulin – the hormone that controls blood sugar.

Type 2 diabetes starts as a person gets older (generally over 40 – although it can appear earlier, especially in people of Asian and African-Caribbean origin). With this type of diabetes, enough insulin is produced, but it is prevented from working properly (a state called insulin resistance).

Type 2 diabetes is the more common type and is linked to being overweight (generally, carrying too much weight around the middle of the body) and not exercising. It is becoming more prevalent in the UK. Some of the older anti-HIV drugs, lipodystrophy, gaining too much weight after starting HIV medicines, and the length of time you have been living with HIV have also been associated with an increased risk of diabetes.

With management, diabetes can be prevented and controlled. Your clinic can test for warning signs of diabetes by measuring your blood sugar when you are fasting.

Usually, the first treatment suggested will be to reduce your weight, especially any excess weight around your middle, through healthy eating and increased physical activity. Walking 10,000 steps each day has been shown to prevent or treat type 2 diabetes. This can, if successful, bring the diabetes under control. In some cases, drugs may be used together with eating and exercise plans.

Many people with HIV are at risk of osteoporosis – a progressive thinning of the bones. Most experts now believe that HIV infection and antiretroviral treatment can both cause bone loss. Other things that can increase the risk for people with HIV include smoking, heavy drinking, a low body weight, and a low testosterone level. The risk increases with age and, for women, with the menopause.  

Nutrition and exercise can both reduce the risk of developing osteoporosis and help deal with bone loss if it occurs.

Calcium and vitamin D are essential to bone formation, so you should try to get plenty of both.

Many foods are rich in calcium including milk and other dairy products, leafy green vegetables, beans and many types of fish. See Healthy Eating for more information on calcium-rich foods.

Vitamin D is found in oily fish and eggs, as well as in foods that are specially fortified, such as some breakfast cereals.

You get most of your vitamin D from sunlight on your skin. People with brown or black skin may have lower levels of vitamin D than people with fairer skin, as can people who aren’t exposed to much sun. However, too much sunlight exposure resulting in reddening or burning of the skin can increase the risk of developing skin cancers. For safer exposure, it’s recommended that you regularly go outside for a few minutes around the middle of the day without sunscreen. This should be enough to raise your vitamin D levels, although this depends on the time of year, the colour of your skin, and how much clothing you wear. Ask at your clinic for further advice on healthy sun exposure.

A dietitian can help you look at your eating habits and see how you can increase the amounts of both vitamin D and calcium in your diet. In some cases, to make sure you get enough of these nutrients you may want to consider taking supplement tablets. You should talk to someone at your HIV clinic or your GP about what you might need to take to correct any deficiency. 

Resistance, or weight-bearing, exercise can reduce the risk of osteoporosis, and can help if it is diagnosed by encouraging new bone to grow. This means any type of exercise in which your muscles are forced to work against gravity. (If you are at risk of bone fracture because of osteoporosis, you should get advice about the sort of exercise that may be safe for you.)

HIV treatment has been associated with kidney problems and sometimes HIV can cause a form of kidney disease. Recent research has shown that people taking HIV treatment have fewer kidney problems than people with HIV who are not taking treatment. Diabetes and high blood pressure can both cause damage to the kidneys.

At first, kidney disease is usually treated with lifestyle changes, aimed at maintaining a healthy weight, through eating a balanced diet and exercising regularly. You should be particularly careful about the amount of salt in your diet, in order to avoid increasing your blood pressure. You may be advised to avoid foods with high levels of potassium as well, and to eat a diet with a moderate amount of protein (not a high- and not a low-protein diet), but you should only do this with the assistance of a dietitian.

The kidneys remove waste products from our body. If they are not working properly, the waste products can build up, causing the symptoms of kidney disease (these include feeling ill and tired, shortness of breath, itching and swelling of the legs). By altering what you eat, you may be able to reduce the levels of certain waste products and reduce the severity of some symptoms. Your healthcare team will be able to tell you what this might involve.

As kidney disease progresses, you may have to limit the amount of fluid you drink – but you should drink normally until you are told to make this change by your healthcare team.