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How many people are affected?
Monitoring changes in fat distribution
Many people are unlikely to notice any changes in body shape. Lipodystrophy occurs more rarely with current drugs compared to the earliest HIV meds. The benefits from treatment still outweigh the risks. For most people any changes are likely to be mild. However, for a minority, problems are more serious. Preventing lipodystophy is more important and more successful than trying to treat lipodystophy after it has developed. As no one can predict who will be affected before starting treatment, careful monitoring is important. You use try switching to other HIV meds if you get symptoms with your first combination.
There are several ways that changes in body fat distribution can be measured and monitored. • Most people are sensitive to physical changes in their body. This means that ‘self-reporting’, perhaps with careful measuring by a dietician, or photography can record any changes. • Some HIV clinics have access to scanning equipment, but unfortunately lipodystrophy is rarely monitored in this way. MRI and DEXA scans look at the breakdown within your body of fat and muscle. A test called BIA (Bio Impedance Analysis) are sometimes used. (See side box on Monitoring Tests). • Getting a DEXA scan, or well-lit photo, even if you only have slight changes, will give you a reference to know how quickly symptoms are progressing or improving. Some specialist clinics, including the lipodystrophy clinic at St Thomas’ Hospital in London, provide baseline DEXA scans to all patients. You can self refer to this clinic. • As with your CD4 and viral load results, a single test result may only provide limited information. You are likely to need several tests over time to monitor changes. If you are worried that you have lipodystrophy, make sure this is taken seriously. You should be offered monitoring and have any treatment choices explained.
July 2012
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