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HIV treatment and nutrition

some medication and some tomatoes on a table

Some antiretrovirals can cause changes to the fats in your body which can lead to other health problems like diabetes or high cholesterol. A healthy diet can help to avoid these.

Does HIV treatment (antiretrovirals) cause health problems?

  1. Some antiretrovirals - mainly those in the protease inhibitor class - can affect the lipids (body fats). This can lead to the levels of cholesterol and triglycerides becoming too high.
  2. Antiretrovirals are also one factor linked to people with HIV developing diabetes.
  3. Some people have had changes to their appearance because of body fat redistribution (lipodystrophy), which is linked to particular antiretrovirals. This was more of a problem in the past when people were taking antiretrovirals that are avoided now.

‘Good’ and ‘bad’ cholesterol

There are two types of cholesterol:

High density lipoprotein (HDL) carries cholesterol to the liver where it is either broken down or removed from the body as a waste product. HDL is known as ‘good cholesterol’ and it is good to have high levels.

Low-density lipoprotein (LDL) takes cholesterol to the cells. If they need it this is fine, but if not it can build up in the walls of the arteries. For this reason LDL is known as ‘bad cholesterol’.

Why is this a problem?

Certain HIV drugs - like some protease inhibitors - can increase the levels of the bad cholesterol in your blood.

High cholesterol can cause narrowing of the arteries and lead to an increased risk of a heart attack or stroke and coronary heart disease. This is because cholesterol can line the arteries and make it difficult for blood to get to your heart and brain.

High cholesterol can also increase the risk of a blood clot.


Triglycerides are fats that can either come from your diet or be made by the liver.

Usually your triglyceride levels rise after you have eaten - especially after a fatty meal - but they usually return to normal.

For some people they stay elevated - this is more common in people who also have low rates of HDL (good) cholesterol. Too many triglycerides in the blood can cause heart problems.

How can I reduce my cholesterol level?

You can lower your cholesterol through making changes to your lifestyle. These include:

  • eating a healthy diet
  • exercising
  • stopping smoking
  • lose weight if you need to – cholesterol levels can increase if you are overweight.

Certain foods can lower (and raise) your cholesterol levels.

Will I have to take medication?

Your doctor may prescribe you statins - a medication to lower cholesterol - if lifestyle changes don’t make a difference.


There are two types of diabetes, Type 1 usually appears when you are a child – it cannot be prevented, it is a lifelong condition.

Type 2 diabetes is related to lifestyle factors, most commonly being overweight. Whatever your HIV status, being obese with a body mass index of 25 or above will increase your risk of Type 2 diabetes.

Ethnicity can also play a part – your chance of developing Type 2 diabetes increases fivefold if you are South Asian or Afro Caribbean. NHS Choices has some in-depth information about risk factors for Type 2 diabetes.

These are the best ways to avoid type 2 diabetes:

  • eat a healthy diet
  • get enough exercise
  • lose weight if you are overweight.

HIV and diabetes

People living with HIV can have various risk factors for diabetes. These include:

  • lifestyle factors such as being overweight or getting too little exercise
  • the fact that people with HIV are now living longer (age is a risk factor for diabetes)
  • some antiretrovirals may play a role in causing diabetes.

Links have been found between Type 2 diabetes and some antiretroviral treatments. These include:

  • AZT
  • indinavir
  • the little used d4T
  • full doses of the booster drug ritonavir.

The good news is that Type 2 diabetes can be managed initially by lifestyle changes including:

  • stopping smoking
  • regular exercise
  • improving your diet
  • losing weight if necessary.

Our Diabetes page has more detailed information about diabetes, lifestyle and antiretrovirals.

Fat redistribution (‘lipodystrophy’)

Fat redistribution - also known as lipodystrophy - used to be more common in people taking certain antiretrovirals.

It's characterised by gaining weight in some places and losing it in others, causing changes to the body's shape and appearance.

What causes lipodystrophy?

Lipodystrophy has been linked to the older antiretroviral drugs d4T and AZT.

These belong to the nucleoside reverse transcriptase inhibitor (NRTIs) class.

As these drugs are now largely avoided - and the antiretrovirals commonly prescribed today rarely cause body fat redistribution - lipodystrophy is now fairly uncommon in the UK.

Some experts also think there could be links to how long someone has had HIV, how damaged their immune system was when they started treatment and other factors such as age, gender and body mass index before starting treatment. However none of these have been proven to cause lipodystrophy.

What happens if you have body fat changes?

People with lipodystrophy tend to lose weight from the:

  • face
  • buttocks
  • arms and legs

and gain weight on the:

  • waist
  • breasts
  • back of the neck
  • neck
  • jaw
  • upper back.

Is there any treatment for lipodystrophy?

If people suffer from fat loss from their face, New Fill or Sculptra (polylactic acid fillers) can often help.

Polylactic acid injections into the face can stimulate the growth of collagen, which can plump out the sunken area.

If people have fat accumulation around the neck, this can be removed surgically, and so can lipomas – small growths of fat usually found on the limbs or trunk of the body.

Can dietary changes help?

People experiencing body fat changes often have metabolic problems which can lead to higher rates of fats (lipids) in the blood.

This can be in the form of raised cholesterol and triglycerides or diabetes. Changes to the diet and regular exercise can help to manage or avoid these conditions.



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  • Soft margarine is highly processed synthetic gunk and should not be consumed under any circumstances!

    It is wholly unnatural and is not 'good' for you by any stretch of the imagination. Recommending corn and sunflower oil is equally as ridiculous.

    Stick to unsalted grass fed butter, cold pressed olive oil and unrefined coconut oil. Many studies have shown that there is no evidence saturated fat is linked to cardio vascular disease.

    This page is full of misinformation.

    Posted 11:25 Sat 31 Oct 2015
  • I thought that the latest research showed that butter isn't the problem it was once thought and that soft margarine was now considered bad because of the hydrogenation of fat involved. I see the commenter below also thinks this.

    What does THT's medical Director say on the subject?


    Posted 17:03 Tue 08 Dec 2015

The Information Standard: Certified member

This article was last reviewed on 12/1/2016 by Anna Peters

Date due for the next review: 12/1/2019

Content Author: Kerri Virani

Current Owner: Kerri Virani

More information:

Cholesterol - Introduction, NHS Choices, 27/8/15

Cholesterol - Treatment, NHS Choices, 27/8/15

What are triglycerides?, Heart UK

Cholesterol, high - Introduction, NHS Inform, 4/10/14

Type 2 diabetes - Overview, NHS Choices, 18/6/14

Type 2 diabetes - Causes, NHS Choices, 18/6/14

Type 2 diabetes - Treatment, NHS Choices, 18/6/14

Living with Type 2 diabetes – looking after yourself, NHS Choices, 18/6/14

Type 1 diabetes - Introduction, NHS Choices, 12/8/14

Sex and diabetes, Diabetes UK, 2015

Lipodystrophy: d4T, AZT, nevirapine, efavirenz, protease inhibitors, iBase, 23/7/11

Lipodystrophy and metabolic changes, iBase, 1/7/12

Polylactic Acid (New Fill or Sculptra), NAM, Aidsmap

Lipodystrophy, NAM, Aidsmap, Michael Carter, 10/4/11

Longer term side effects, NAM, Aidsmap

Preventing high cholesterol, NHS Choices, 27/8/15

Type 1 diabetes, NHS Choices, 12/8/14

Reduce your diabetes risk, NHS Choices, 1/10/14

Causes of Atherosclerosis, NHS

Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. Mozaffarian D. et al, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, US 23;7(3):e1000252 (March 2010)

Why obesity gives you diabetes, BBC News (2004)

Diabetes and Obesity Rate Soar, Diabetes UK (2009) 

5 A Day, NHS

Fruit And Veg, Eat Well, Be Well, FSA

Mitri J. et al. Diabetes medications and body weight, University Medical School, Roger Williams Hospital, Providence, USA, 2009, 8(5):573-84 (wt loss)

Temperature Control, House Rules (2005)