References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Lipodystrophy is a condition where body fat is redistributed or lost, often affecting people on certain HIV treatments. It was much more common with older antiretroviral drugs and is now rarely seen with modern HIV medications. If you were diagnosed with HIV before 2010 and took older drugs, you may have noticed changes in your body shape over time.
Modern HIV regimens have largely eliminated this problem, but understanding lipodystrophy helps explain why newer drugs are preferred.
What Is Lipodystrophy?
Lipodystrophy refers to abnormal changes in body fat. In HIV, it typically involves two patterns:
- Lipoatrophy: Loss of fat under the skin, usually affecting the face, arms, legs, and buttocks. Causes a gaunt or sunken appearance.
- Lipohypertrophy: Fat accumulation in the abdomen, breasts, or back of the neck (“buffalo hump”). Can cause a protruding belly or fullness around the shoulders.
Which HIV Drugs Cause Lipodystrophy?
| Drug | Class | Lipodystrophy Risk |
|---|---|---|
| Stavudine (d4T) | NRTI | High — no longer used |
| Zidovudine (AZT) | NRTI | Moderate — rarely used now |
| Older protease inhibitors | PI | Moderate (fat accumulation) |
| Modern NRTIs (tenofovir, abacavir) | NRTI | Very low |
| Integrase inhibitors (dolutegravir, bictegravir) | INSTI | Weight gain but not classic lipodystrophy |
Can Lipodystrophy Be Reversed?
Partially. Switching from the offending drug often stops further progression and may allow some recovery, particularly for fat accumulation. Fat loss from lipoatrophy is harder to reverse. Treatment options include:
- Switching antiretroviral regimen to modern drugs
- Diet and exercise for fat accumulation
- Facial filler injections for cosmetic improvement of lipoatrophy
- Tesamorelin (growth hormone releasing factor) for abdominal fat — specialist use
Weight Gain with Modern HIV Drugs
While classic lipodystrophy is rare with modern drugs, weight gain is a recognised side effect of integrase inhibitors (particularly dolutegravir and bictegravir) and tenofovir alafenamide (TAF). This is different from lipodystrophy — it’s generalised weight gain rather than abnormal fat redistribution.
Read more: What is HIV? | Starting HIV treatment | ART side effects
Frequently Asked Questions
Will I get lipodystrophy on modern HIV treatment?
Classic lipodystrophy is very unlikely with modern regimens. However, weight gain is a common side effect of integrase inhibitors and should be discussed with your HIV specialist.
Can I switch drugs if I have lipodystrophy?
Yes. If you’re still on older drugs associated with lipodystrophy, discuss switching with your HIV specialist. Modern regimens are much less likely to cause this problem.
Related reading
- Injectable HIV Treatment: Everything You Need to Know
- Are HIV Tests Accurate If You're on PrEP, PEP or ART?
- CD4/CD8 Ratio: What It Means and Why It Matters
- CD4 Counts Explained: What Your Numbers Mean
- Changing HIV Treatment: When, Why and How
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
