Whilst fat loss tends to be the main exercise goal for much of the general population, for people with HIV there’s historically been more focus on gaining and maintaining weight than losing it.
Muscle wasting was a significant problem for PLHIV before the HAART era and maintaining protein reserves and some body fat is useful at times of illness, when appetite and energy may be low. If you are interested in gaining weight and building muscle then see our section on fitness goals.
Although new HIV medications in the late 90s massively improved health and life expectancy and reduced the level of HIV-related muscle wasting, some of the earlier drugs (NRTIs such as D4T, DDI, DDC) caused lipodystrophy.
This metabolic syndrome can cause fat loss from the arms, legs, buttocks and face and in some cases the redistribution of fat to other areas (stomach, breasts, upper back and neck).
It can also increase levels of fats (lipids/cholesterol/triglycerides) in the blood stream, which increase the risk of cardiovascular problems. Thankfully, with newer and better formulations of ARVs, lipodystrophy is much rarer today.
First of all, if you are still taking any of the older drugs, changing medications should stop things getting any worse.
Although some studies have shown that Human Growth Hormone can be effective in reducing abdominal fat, its high cost and frequent severe side effects mean that it is not likely to be prescribed through the NHS.
Other than this, exercise is the only intervention that has been shown to reverse the progress of lipodystrophy in relation to general body shape.
However, this does not apply to facial wasting, which needs to be treated with Newfill injections.
Studies show that a combination of cardiovascular exercise and resistance (weight) training was the only thing which helped reduce the appearance of fat around the stomach area in men.
Whilst it may not be possible to get rid of all the fat that has accumulated (depending on how severe the lipodystrophy might be), reducing some of the fat and building muscle in the areas where it has been lost (arms, legs, buttocks) can reduce the severity of the condition and improve your body proportions and appearance.
As exercise is an extremely effective way of reducing bad blood fats and increasing the good fats, not only will it combat the outward signs of lipodystrophy, but it will also improve the inner fat issues which, although invisible, are the greater health concern in the long term.
Doctors often prescribe drugs to reduce cholesterol and triglyceride levels, and whilst these are effective, they can have their own side effects and are yet more pills to take.
Exercise on the other hand will do the same job and provide you with a health investment for the future in terms of cardiovascular risk factors, improved appetite, sleep, bone density, mood and self esteem.
If there’s a better answer than this, it has yet to be found!
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What about lipoatrophy?
I am unable to retain any body fat because of the HIV meds I take. Changing treatment is not really an option as I seem to react adversely to most of the treatments available.
I eat fatty food all the time, but weigh around seven stone - and it's very hard to keep weight on let alone gain any.
These pages are full of bad information, lack the fuller picture about diet and HIV and are overdue for review.
This article was last reviewed on
by Anna Peters
Date due for the next review: 11/4/2019
Content Author: G. Brough
Current Owner: G. Brough
Weight loss and survival in HIV-positive patients in the era of HAART, Tufts University (2002)
Pilot of exercise training to reduce trunk fat in adults with HIV-associated fat redistribution, Tufts University (1999)
Reduction of abdominal obesity in lipodystrophy by means of diet and exercise, Tufts University (2002)
Comparison of clinical & cost-effectiveness of 3 intervention strategies for AIDS wasting, Tufts University (2005)
Short-term PRT increases strength and lean body mass, Tufts University (1999)
Reduction of fat accumulation and lipid disorders, NCPAD (2002)
Short-term exercise improves body composition, NCPAD (2001)
Exercise treatment to counteract protein wasting, NCPAD (2003)
Resistance exercise reduces hypertriglyceridemia, Journal of Applied Physiology (2000)
Use of diet, nutritional supplements and exercise in HIV-infected patients, Nutrition and Dietetics Unit, Endocrinology Service, Hospital Clinic de Barcelona
Effects of progressive resistive exercise in adults living with HIV/AIDS, University of Toronto (2008)
Human Growth Hormone, NAM
Various people talk about their experiences of living with HIV.
CAB - Citizens Advice Bureau
HIV Drug Interactions
George House Trust
Equality and Human Rights Commission
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