Question:

I am a 45-year-old male and have been HIV positive for about 2 years. My CD4 count is in the normal range, and when I had my last labs, it was about 750. My viral load was 391. I am not on meds and have not been since my diagnosis.

Over the past several months, I seem to have been losing fat in my face. Other people have remarked on this, so it's not just my imagination. Could this be related to HIV? I have heard of this happening in people who are on ARVs, especially protease inhibitors, but I haven't heard of it in people who aren't on meds.

Is there anything I can do about this short of plastic surgery? (For example, would it help to eat more?) Should I be concerned about this from something other than a cosmetic perspective?

Many thanks.

Answer provided by:

Ross Slotten, M.D.
Klein and Slotten Medical Associates
Private Practice in Family Medicine
With a special interest in HIV disease

You state that you've been HIV positive for approximately 2 years and are doing well (your CD4 count is high and your viral load very low), but have noticed loss of fat in the face. Friends have noticed this also.

Of course, without knowing you or seeing a picture of you, it's difficult to comment on your particular situation, but I'll make an attempt. There are several possible explanations for your apparent body-shape changes. First, if you've lost any weight (either through more vigorous dieting and exercise in order to keep yourself healthy, after having received your diagnosis), you'll also lose fat in the face--that's not abnormal. Second, the fat loss may be a normal part of the aging process, though you certainly aren't old, but you're not young either. Third, this is a form of the lipodystrophy, or fat redistribution syndrome. The lipodystrophy syndrome can occur in people who've never received HIV treatment. Studies have demonstrated abnormalities in cell mitochondria (the reputed source of the lipodystrophy syndrome) in HIV-positive individuals who have never been treated. These abnormalities are enhanced significantly with HIV meds. They are not found in HIV-negative individuals. But I'm not convinced that you truly are suffering from this syndrome.

My suggestion would be to photograph yourself once a month, to see if there truly is a progression of your symptoms. If they continue to progress, despite maintenance of your weight, you could consult a plastic surgeon. However, you are probably more aware of your body now than you were three years ago; and the changes you're noting may not be significant.

I hope this helpful.

060501
ASKD060502

AEGiS is a 501(c)3, not-for-profit, tax-exempt, educational corporation. AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, John M. Lloyd Foundation, Roche and Trimeris, the National Library of Medicine, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, and donations from users like you. Always watch for outdated information. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2006. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.