Duration of treatment

The likelihood of physical fat changes may increase with the amount of time on HAART. The emergence of lipodystrophy has been associated with the length of time on protease inhibitors and NRTIs in some studies.1 2 3 However, the prevalence of body fat changes stabilised in the large MACS study after two years of treatment, which may suggest that some individuals are not at risk of lipodystrophy no matter how long they stay on treatments.4

Several studies have found that new cases of lipodystrophy were still being being diagnosed in people who had been taking antiretroviral therapy for at least three years.3 5 6

Some studies have also observed an initial gain in limb fat in men over the first few months of treatment (to week 24), followed by a significant loss of limb fat, in many cases to below baseline levels.7 8

Lipodystrophy may appear in people being treated for primary infection. In several small studies, many patients treated during primary infection have self-reported the appearance of lipodystrophy. In one study, this was clinically confirmed in 15% of the cases after an average of one year of treatment, and in 26% in the other after an average of 19 months.9 10 Fat accumulation has also been reported after two four-week courses of post-exposure prophylaxis.11

Prolonged treatment with an NNRTI-based combination has been associated with reduced risk of lipodystrophy when compared with prolonged PI treatment.12

References

  1. Duncombe C et al. Reversal of hyperlipidemia and lipodystrophy in patients switching therapy to nelfinavir. J Acquir Immune Defic Syndr 24: 78-79, 2000
  2. Carr A et al. A HIV protease inhibitor substitution in patients with lipodystrophy: a randomized, controlled, open-label, multicentre study. AIDS 15: 1811-1822, 2001
  3. Lichtenstein K et al. Clinical assessment of HIV-associated lipodystrophy in an ambulatory population. AIDS 15(11): 1389-1398, 2001
  4. Kingsley L et al. Prevalence of lipodystrophy and metabolic abnormalities in the Multicenter AIDS Cohort Study (MACS). Eighth Conference on Retroviruses and Opportunistic Infections, Chicago, abstract 538, 2001
  5. Lichtenstein KA et al. Incidence of and risk factors for lipoatrophy (abnormal fat loss) in ambulatory HIV-1-infected patients. J Acquir Immune Defic Syndr. 32(1):48-56, 2003
  6. Jacobson DL et al. Evolution of fat atrophy (FA) and fat deposition (FD) over 1 year in a cohort of HIV-infected men and women. Ninth Conference on Retroviruses and Opportunistic Infections, Seattle, abstract 685, 2002
  7. Dubé MP et al. Prospective study of regional body composition in antiretroviral-naive subjects randomised to receive zidovudine + lamivudine or didanosine + stavudine combined with nelfinavir, efavirenz or both: A5005s, a substudy of ACTG 384. Antiviral Therapy 7: L18 (abstract 27), 2002b
  8. Mallon P et al. Prospective evaluation of the effects of antiretroviral therapy on body composition in HIV-1 infected men starting therapy. AIDS 17: 971-979, 2003
  9. Miller J et al. Lipodystrophy following antiretroviral therapy of primary HIV infection. AIDS 14: 2406-2407, 2000
  10. Goujard C et al. Incidence of clinical lipodystrophy in HIV-infected patients treated during primary infection. AIDS 15(2): 282-284, 2001
  11. Mauss S et al. Rapid development of central adiposity after antiretroviral exposure - a proof of principle. Antiviral Therapy 7: L51 (abstract 77), 2002b
  12. Mauss S et al. Risk factors for the HIV-associated lipodystrophy syndrome in a closed cohort of patients after 3 years of antiretroviral treatment. HIV Medicine 3(1): 49-55, 2002
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.