Obesity is characterized by an excess of fatty tissue, which makes it similar to lipohypertrophy, an HIV-related fat build-up that’s the leading cause of the buffalo hump in the upper back, but can also cause fat to accumulate in other areas of your body, like your neck.
Ironically, this excess accumulation of fat can coexist with another HIV-related condition, lipoatrophy, in which fat loss occurs in the face or limbs. Also known as wasting, lipoatrophy is indelibly etched into our communal subconscious by images of people living with AIDS in the 1980s.
Lipohypertrophy has been linked to HIV itself as well as the drugs used to treat the virus. Adding to the complexity, Dr. Jordan E. Lake, an infectious disease specialist with McGovern Medical School of University of Texas Health Science Center at Houston, tells Plus, people with HIV can experience obesity at the same time as lipohypertrophy or lipoatrophy. (Yes, you can have a gaunt face, beer belly, and buffalo hump all at once.)
“As the obesity epidemic overlaps with the HIV epidemic,” Lake says, “it is becoming harder to isolate what component of central weight gain is [obesity] and what is lipohypertrophy. The take home point is that increased visceral fat through whatever mechanism has detrimental metabolic effects.”
Lake is the lead author of a new study published recently in Clinical Infectious Diseases, in which researchers from 12 universities raise concerns, noting that overweight or obese HIV-positive people have more than a 67 percent chance of having other health problems, including “detrimental effects on muscle,” osteoarthritis, neurocognitive dysfunction, cardiovascular disease, and diabetes. In addition, the report notes, “Body fat changes are stigmatizing and may impact self-esteem, affect ART adherence, lead to depression, and decrease quality of life.”
The researchers recommend doctors monitor HIV-positive patients’s weight, as “prevention and early intervention are likely more effective than reversing fat accumulation.”
Indeed, there aren’t that many (successful) treatments for obesity. The first involves “structured exercise with or without dietary intervention.” There are also a handful of pharmaceutical options, although some, like orlistat (Alli, Xenical) and naltrexone/bupropion (Contrave) aren’t recommended for people on antiretroviral medications (orlistat is particularly dangerous as it can cause ART to fail).
The study notes bariatric weight loss surgery “is the most effective treatment for obesity, resulting in an average 60-70 percent loss of excess body weight,” but these surgeries have mixed reviews when it comes to people with HIV, and should only be considered after “serious attempts at lifestyle changes.”
There are even fewer treatments for those dealing with lipohypertrophy, Lake says. In fact, “Egrifta [tesamorelin] is the only FDA-approved pharmacologic therapy to reduce visceral fat in HIV-infected persons.”
Although many have turned to liposuction to deal with HIV-related fat deposits, Lake says, “These are separate issues. Liposuction doesn’t improve the health of the fat, and is used for cosmetic purposes only. You can only remove subcutaneous fat — fat under the skin — with liposuction. Fat in different parts of the body behaves differently. The ‘buffalo hump,’ for example, isn’t as metabolically active as abdominal visceral fat — fat around and in the organs of the body.” That can make it harder to remove through liposuction.
But, Lake adds, stimulating the visceral depot to reduce its size, which is what tesamorelin does, “has clear metabolic and inflammatory benefits.”