Physical and Biochemical Changes in HIV Disease (cont.)

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.

What new physical abnormalities have occurred in HIV infection and why?

During the last 5 years, the field has been turned upside down by the increasing frequency of HIV patients who have developed new physical abnormalities. These abnormalities are frequently referred to as lipodystrophy, meaning abnormalities in body fat distribution (accumulation or loss of fat in different areas of the body). These changes include abnormal collections of fat that result in humps on the back of the neck, breast enlargement, and protuberant bellies. Others experience loss of fat under the skin (subcutaneous) in the arms and legs (extremities) that results in the appearance of prominent veins in the extremities. Loss of fat also causes flattening of the buttocks and sunken cheeks (due to loss of facial fat).

As a matter of fact, these physical changes have become sufficiently common, so that in many communities, patients are identified as being HIV infected while walking on the street, at the gym, or on the beach. Moreover, these physical changes are as stigmatizing as the wasting and skin lesions of the earlier years of the epidemic. These newer problems, however, are emerging ironically in patients with high (favorable) T-cell counts and undetectable viral loads (measure of virus in the blood). Such patients are unlikely to succumb to HIV disease in the coming years or even decades.

These physical abnormalities can be associated with low self-esteem, depression, and, as mentioned, stigmatization. What's more, they can profoundly influence the patients' decisions as to whether to start antiretroviral therapy or continue such medications. In addition, the fat collections around the neck can cause neck pain, while breast enlargement from fat accumulation can cause back pain. Finally, the fat accumulation that causes protuberance of the belly can also cause hernias (bulging) around the belly button and gastroesophageal reflux (GERD) because of increasing pressure in the stomach. When severe, the fat in the belly (abdomen) can even make it difficult to breathe because of pressure on the lungs.