Guide to side effects and complications
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Fat accumulation
Associated drugs: nukes, NNRTIs, protease inhibitors, possibly integrase inhibitors
Symptoms Fat accumulation can occur in the abdomen, breasts, neck and shoulders. It can occur in both men and women. Small bumps or collections of fat, called lipomas, can occur under the skin in other parts of the body including the pubis. A hard fatty lump in a mans breast is called gynaecomastia. Abdominal fat accumulation associated with lipodystrophy is generally visceral (VAT) rather than subcutaneous (SAT) adipose tissue. Visceral fat is around the organs inside the abdomen rather than fat just under your skin (‘love handles’). With visceral fat your stomach wall is pushed out from inside. Your stomach muscles can sometimes be quite defined, but your stomach will still be extended. In severe cases, this can compress your internal organs and interfere with normal functions like breathing and eating. In these cases there is a greater medical urgency to reverse the fat accumulation. This may help you access treatments like growth hormone releasing factor (GHRF, tesamorelin), growth hormone (rHGH) or to switch to drugs like T-20 or raltegravir.
Treatments for fat accumulation Many of the approaches used to lower cholesterol and triglycerides are being studied to treat fat accumulation. These include diet, exercise and research drugs. Using more than one approach may be important. For example, using diet and exercise when switching the drug most likely to be causing problems. And
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similarly using diet and exercise when using any treatment. HIV-related fat accumulation seems to be due to your body signalling itself to produce more fat. Dietary fat is not the only mechanism, but high fat diets are unlikely to help. Whatever the cause, diet and exercise seem to be useful in helping reverse these changes. Anabolic steroids are not recommended for fat accumulation as they could worsen fat loss in other parts of the body. Metformin can reduce central fat accumulation in people who already have insulin resistance but should not be used if you have a low BMI. Recombinant Human Growth Hormone (rHGH) can reduce visceral abdominal fat and fat pads from the back of the neck and shoulders. Side effects, including the risk of insulin resistance and diabetes, are reduced using lower doses in more recent studies. Fat accumulation appears to return if rHGH is stopped. A Growth Hormone Releasing Factor called tesamorelin (formerly TH-9507, tradename Egrifta) that can reduce visceral fat by 20% was approved in the US in 2010. It had less side effects than rHGH but there is no long-term data (maximum one year). Tesamorelin is a continual treatment and fat returns if the treatment is stopped. A lower maintenance dose of tesamorelin has not been established. Neither tesamorelin nor rHGH are approved in Europe as treatments for lipodystrophy. However, rHGH can be prescribed off-label on an individual July 2012