Lipodystrophy is when a person can no longer store or use their body fat as effectively. This could mean they gain or lose fat in different parts of the body. Older antiretroviral treatments (ARTs) may cause HIV-related lipodystrophy.

Experts do not know the exact cause of HIV-related lipodystrophy. They believe it may be due to some ARTs, such as nucleotide reverse transcriptase inhibitors (NRTIs). These include medications stavudine and zidovudine.

Some older protease inhibitors (PIs), such as indinavir, may also cause changes in body fat. By contrast, newer ARTs do not cause HIV-related lipodystrophy.

HIV can also affect a person’s body fat distribution, especially if they have trouble eating.

In this article, we discuss HIV-related lipodystrophy, including symptoms, diagnosis, and treatment.

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Around 10–80% of people living with HIV experience HIV-related lipodystrophy. NRTIs and older PIs tend to cause body fat changes in people with the virus.

Researchers are not sure why some ARTs affect a person’s body fat. They suspect these medications may change the structure of fat cells.

When a person contracts HIV, their immune system becomes activated. Research suggests that people with higher levels of immune activation experience greater gains in body fat with some ARTs.

Some people also experience significant fat loss from the face when they start taking highly active ARTs.

If a person has concerns about any side effects of the ART they are using, they should speak with a healthcare professional.

Under no circumstances should they stop taking their medications without letting their doctor know first, as they could be putting themselves at risk of HIV complications.

HIV-related lipodystrophy occurs when a person contracts HIV or starts ART. Lipodystrophy can mean both fat gain, or lipohypertrophy, and fat loss, also known as lipoatrophy.

Parts of the body where a person could gain fat include:

  • around the abdomen
  • in between the shoulders, behind the neck, causing the so-called buffalo hump
  • breasts

Parts of the body where a person could lose fat include:

  • arms and legs
  • buttocks
  • face

It is important to note that modern ARTs do not cause HIV-related lipodystrophy. If a person is concerned about the type of ART they are taking, they should speak with a doctor to potentially look into other treatment methods.

Before diagnosing HIV-related lipodystrophy, a doctor will collect an individual’s personal and family medical history to see whether anyone has diabetes or cardiovascular disease.

They will then conduct a physical exam including measurements such as waist circumference and body mass index.

If they conclude a person has lipoatrophy, that is, they are losing a lot of fat, the doctor will look for signs such as sunken eyes and hollow cheeks.

Alternatively, if they diagnose lipohypertrophy, or body fat gain, they may check the size of the breasts in both males and females. A person may also accumulate fat in the back and present with a dorsocervical fat pad known as a buffalo hump.

There are a number of ways a person can manage and treat HIV-related lipodystrophy. Methods include:


Egrifta is a medicine that specifically reduces abdominal body fat in people with HIV. The Food and Drug Administration (FDA) approved its use for HIV-related lipodystrophy in 2010.

A person should keep Egrifta in the fridge and away from light. When preparing the medication for injection, they need to gently roll the vial in their hands for 30 seconds.


When people contract HIV or begin ART, they may develop insulin resistance, meaning they can no longer control their blood sugar as well.

Metformin is a drug that helps lower blood sugar levels and is a first-line treatment for diabetes.

However, research suggests it is also effective at helping individuals who have obesity and insulin resistance lose weight.

Tumescent liposuction

Tumescent liposuction involves removing fat from particular areas of the body.

During the procedure, a doctor numbs the area where they are removing fat with a local anesthetic, rather than using general anesthesia, which is typical for traditional liposuction.

A person with HIV-related lipodystrophy may consider this treatment if they have gained fat in undesirable areas of the body.

Fat transfer

If a person with HIV notices they are losing a lot of fat from their face after using ART, they can get dermal fillers or fat transfers to the face.

Fat transfers tend to be less expensive than dermal fillers and are just as durable.


Radiesse is a soft-tissue filler that helps build up a person’s facial structure. The FDA indicates it for HIV-related lipodystrophy.

When people lose fat from their face, they may develop nasolabial folds, which are deep lines that appear at the side of the mouth. They start at the edge of the nose and extend to the outer corners of the mouth. They are more noticeable when people smile.

HIV-related lipodystrophy is a complication of some ARTs. A person can manage their fat loss or fat gain with a variety of treatments, which can either increase or decrease fat in particular areas of the body.

Some of the treatments are not a quick fix, and a person will most likely need to keep them up for as long as they are using ART.

Older ARTs, such as NRTIs and some PIs, may cause HIV-related lipodystrophy. This means a person gains or loses fat in different parts of the body.

While researchers do not exactly know why this happens, they think it may be because these medications alter the structure of fat cells.

There are many treatments that people who develop HIV-related lipodystrophy can choose from, depending on whether they want to remove fat, or build up fat in certain areas that have lost it.

Treatment options that reduce fat include medications such as Egrifta and metformin and procedures such as tumescent liposuction. Treatments that help regain facial structure from lost fat include fat transfers and facial fillers.