Physical and Biochemical Changes in HIV Disease

A frequently used saying among those who care for patients with HIV disease is that the availability of potent antiretroviral therapy has changed the "face" of the HIV, or AIDS, epidemic. Generally, this refers to the dramatic decrease in AIDS-related complications and deaths as a result of these treatments. Unfortunately, however, this saying is also literally all too true. You see, our patients are experiencing a variety of unusual physical changes, including changes in the appearance of the face, that are associated with their HIV disease and its treatment.

While patients tend to focus on the physical changes, clinicians are also concerned about abnormalities in blood lipids (elevated cholesterol and triglyceride fats) and glucose (elevated blood sugar, as in diabetes). The observed changes are collectively often referred to as the biochemical (metabolic) and physical (morphologic) symptoms (manifestations) of HIV disease and highly active antiretroviral therapy. And, in fact, they have had a major impact on how HIV is treated in the current era.

Lipid abnormalities and physical changes are not new to people with HIV disease. In the early years of the epidemic, many patients with HIV experienced high levels of fat (triglycerides) circulating in their blood. At the time, this laboratory abnormality was generally of little significance to the patients or their doctors. In addition, many with HIV experienced wasting (severe weight loss) and skin lesions (abnormalities) that were stigmatizing (marks of discredit). The weight loss and skin lesions occurred most often in those with the advanced stages of AIDS.