Lipodystrophy
Chewing the Fat New
and disturbing side effects from Protease Inhibitors.

Protease Inhibitors (PI’s) taken together with at least two other anti-HIV drugs- is a powerful weapon in the fight against HIV/AIDS. The media hypes this treatment as a cure; in fact, we see a 50% decline in the death rate. PI's have been with us for two years, however, so we know that they are not a "cure". In addition, reports of unusual side effects are gaining attention.

A Ballooning Problem [very funny!]
Some people taking PI's complain that their bodies are changing. They lose weight in their faces, which gives them a gaunt and wasted look. Their arms become skinnier. At the same time, their waistlines thicken and become larger (this is called truncal obesity), and they develop fat mounds ("buffalo humps") on the backs of their necks. The medical term for these changes is lipodystrophy, an abnormal distribution of fat in the body. People also experience higher than normal amounts of fats --cholesterol and triglycerides--circulating in the bloodstream. This is dangerous because too much fat in the blood can lead to illnesses such as heart attacks and strokes.

Although men were the first to complain about these changes, women have not escaped them. Many women who take PI's see a thickening waist, narrowing hips, and painful [no reports of it being painful, that I saw] breast enlargement. The problem was first noticed in people taking Crixivan, so it got called "Crix belly". However, this is not limited to Crixivan: all of the available PI's have been associated with these changes.

What Causes These Side Effects?
Medical experts are uncertain about what causes these side effects. One theory is that the PI's block a substance in the liver that normally filters fat from the bloodstream. However, not all the people taking PI's have these body changes. Depending on how it is measured, this problem is present in 11% to 64% of people taking PI's!

Another theory is that people with HIV/AIDS already have trouble metabolizing fat. Some people who are NOT taking or have never taken a protease inhibitor also experience these changes, however. Even a few people who are HIV negative have had these problems. Although changes happen much more often in HIV positive people who are taking PI's, the solution is not so simple as saying "Taking PI's causes the body to process fats badly."

What to Do?
These changes in a woman's body can be very upsetting, especially when they happen to you. There is more involved than [I took out “just”, as body image is important and should not be belittled] vanity or body image. No one knows for sure if the changes in body shape are dangerous to a woman's health.

Some people have become so upset at the way their bodies have changed that they have quit taking their protease inhibitors. This is dangerous because it allows the HIV virus to grow unchecked and may speed the development of AIDS. If you are having any of these symptoms--weight loss in the face, arms, or legs, a pot belly, "buffalo hump", or your breasts are getting bigger and your hips are getting narrower--report them immediately to your health care provider. Together, you and your provider can decide what works for you.

Scientists are starting to investigate this problem, but most of the studies are done with men. Because women's bodies often react differently than men's to the same problem, many more women need to be studied. If you are interested in this, ask your provider to tell you when there are studies starting in Seattle.

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