Researchers from 12 universities from across the U.S. and Europe (as well as Canada) have released a consensus statement about obesity and lipohypertrophy among people living with HIV.
Lipohypertrophy is a side effect of a handful of antiretroviral drugs, and it causes fatty deposits to form in specific places on the body. It can lead to a “buffalo hump” on the back, but it can also cause localized fat accumulation in the abdomen, neck, and other areas. Published in The Journal of Infectious Diseases seeks to help develop a standard for the diagnosis and treatment of excess fatty tissue among those living with HIV.
The authors set out the current knowledge about lipohypertrophy, its association with HIV medications, diagnosis guidelines, treatment options and how it both differs from and shares “clinical consequences” with obesity.
Up until now, there has not been a set of standardized symptoms for doctors to turn to when diagnosing HIV-related fat accumulation, or distinguishing it from general obesity (which is also an over accumulation of fatty tissue). As the authors write, “Both generalized obesity and lipohypertrophy are prevalent” among those on ART (although rates of the latter may be going down with new antiretroviral medications). Both conditions have potential long-term impacts, including on cardiovascular and metabolic health, so should be prevented from developing or treated early.
There are not a lot of treatment options for either obesity or lipohypertrophy. The authors point to “structured exercise with or without dietary intervention” as being the most successful treatment for “abdominal obesity in most studies of HIV-[positive] persons.” Of course, there are also multiple weight loss drugs, but the authors acknowledge, “No agent has emerged as first line therapy,” and some require “caution” when prescribed to HIV-positive people, due to their potential interactions with antiretroviral medication.
While surgical interventions like bariatric surgery have been successful in treating obesity, liposuction as a treatment of lipohypertrophy often fails to have a lasting impact. “Fat accumulation may recur,” the researchers explain, “requiring repeat procedures. Large studies are lacking, with case studies reporting recurrence rates from 0-50 percent. Data on the metabolic effects of surgical fat removal are also lacking.”
Tesamorelin (Theratechnologies’ Egrifta), is a growth-hormone releasing factor analog, that is the only Federal Drug Administration approved drug to reduce excess abdominal fat in those with HIV who are on ART. The drug, which is administered via injection, must be taken consistently; if stopped the fat can reappear within six months.
In conclusion, the authors note, “Prevention and treatment of these disease states are critical to the present and future health of HIV-[positive] persons. Although promising treatment strategies exist, further research is needed to better understand the pathophysiology and optimal treatment of obesity and lipohypertrophy in the modern ART era.”