The metabolic disorders most commonly seen in people with HIV, include:

• Lipodystrophy


• Hypogonadism


• Wasting syndrome


• Diabetes

Lipodystrophy

Lipodystrophy is a medical condition that involves changes in body fat. For example, if you are HIV+ and you have lipodystrophy, you may get abnormal fat deposits in your stomach or neck. You may also lose fat from your legs, arms, and face. In addition to changes in body fat, lipodystrophy may also involve changes in fat and cholesterol levels in the blood, an increase in blood pressure, and may cause you to develop early signs of diabetes or heart disease.

Causes of Lipodystrophy Lipodystrophy can be caused by anti-HIV medications or HIV infection. However, the actual causes of lipodystrophy remain unclear.

Treating Lipodystrophy

Because of this uncertainty, treating lipodystrophy can be tricky. If you have lipodystrophy, there are treatment options:

• Changing your HIV medications—if you are taking an HIV medication that is suspected to cause lipodystrophy, your healthcare provider may suggest that you switch to a different medication


• Liposuction and plastic surgery—liposuction is a procedure that vacuums out excess fat. Liposuction can be used to remove excess fat from the necks of people with HIV with lipodystrophy. Breast reduction has also been used in both men and women with HIV to get rid of excess fat deposits. You should be aware that there are risks involved with surgery, and the fat deposits have been known to come back. If you have lipodystrophy and are interested in these types of procedures, be sure to talk to your healthcare provider to get more details


• Other treatment options may be available. Talk to your healthcare provider about what treatments may be right for you

Hypogonadism

In some men with HIV, the amount of male hormone or testosterone produced in the testicles decreases. This condition is known as hypogonadism. If you are a man with HIV, and you are low on energy or depressed, talk to your healthcare provider. Your healthcare provider can conduct a blood test to check your testosterone levels. If you do have hypogonadism., your healthcare provider can prescribe medication to restore your testosterone levels.

Wasting Syndrome

Wasting syndrome is the term used to describe involuntary weight loss, in which a person with HIV has lost more than 10% of his or her body weight. It is one of the most common symptoms of HIV infection. Wasting syndrome can be a sign that HIV infection is getting worse. This is because weight loss without trying is a sign of malnutrition, and malnutrition can lead to additional weakening of the immune system.

Causes and Treatment Options for Wasting Syndrome

Involuntary weight loss can be caused by a number of factors, such as poor food absorption, diarrhea, eating less, and infections. If you are HIV+ and have wasting, there are a number of things you and your healthcare provider can do:

• Starting anti-HIV medications—you are HIV+ and not currently on anti-HIV medications, there is evidence that starting highly active antiretroviral therapy or HAART may help you gain weight


• Human growth hormone—high doses of human growth hormone can increase muscle mass in people with wasting syndrome. However, you should be aware that this is considered to be experimental treatment for wasting syndrome


• Nutritional supplements—there are liquid supplements available for people with HIV who eat but still do not gain weight or have trouble eating solid foods. Talk to your healthcare provider about the best types of nutritional supplements to use for wasting syndrome


• Testosterone replacement—testosterone is the male sex hormone, and it can promote muscle growth, reduce fatigue, and increase appetite. However, there is still some disagreement among healthcare providers about the use of testosterone to treat wasting syndrome. Testosterone replacement is available in the form of skin patches or injections


• Steroids—steroids have effects similar to testosterone. However, many healthcare providers prefer the use of testosterone over steroids because steroids can cause liver problems. If you take steroids for wasting syndrome, it is necessary for you and your healthcare provider to regularly monitor your liver for possible side effects

Diabetes

Diabetes, sometimes referred to as having "sweet blood," is a disease in which your body does not produce enough insulin or does not respond to the production of insulin. Insulin, a hormone made by the pancreas, is responsible for controlling the amount of sugar in your blood. Sugar acts as fuel for your body. However, if there is too much sugar in your blood, then there is not enough getting to your cells. There are 2 major types of diabetes:

• Type 1 diabetes—in this type of diabetes, your body is not capable of producing enough insulin. Type 1 diabetes is usually diagnosed in childhood, and so, it is also called juvenile diabetes


• Type 2 diabetes—this type of diabetes is caused by not being able to respond to the insulin produced by your body. Type 2 diabetes can be caused by a number of factors, such as being overweight, a lack of exercise, and aging.

Symptoms and Complications of Type 2 Diabetes

There are many symptoms that can be signs of type 2 diabetes:

• Being low on energy
• Having to urinate often
• Being thirsty often
• Having blurry vision

If you have any of these symptoms, it is important to talk to your healthcare provider right away. If left untreated, type 2 diabetes can cause serious health problems, such as:

• Lesions in the eye
• Kidney disorders
• Nerve damage, especially in the legs
• Inability to get and maintain an erection
• Bacterial or fungal skin infections
• Heart disease

Monitoring and Treating Type 2 Diabetes

If you are HIV+ and are on anti-HIV medication, it is important for you and your healthcare provider to keep an eye on your blood sugar levels. This can be done through a blood test called a fasting plasma glucose test, or FPG. An FPG test score of 100 or less is normal. If your FPG test score is higher than 100 but lower than 126, you are considered prediabetic. If your FPG score is higher than 126, your healthcare provider will diagnose you with type 2 diabetes.

If you are HIV+ and you are diagnosed with or have type 2 diabetes, there are 3 things that you and your healthcare provider should discuss:

• Exercise—exercising can help bring your blood sugar levels back to normal. Taking a long, brisk walk once a day can be enough. Other forms of exercise that may help include jogging, swimming, bicycle riding, or aerobics


• Diet—this is a very important part of your treatment for type 2 diabetes. It is important to increase the amount of fiber in your diet. You can do this by eating more beans, fresh fruit, whole grains, and vegetables. It is equally important to reduce the amount of certain types of foods in your diet. These foods include butter, lard, cream, margarine, cake, biscuits, and, of course, sugar. Before starting any special diet, you should definitely talk with your healthcare provider about what is best for you. Finally, if you would like more insight into the recommended diets for type 2 diabetes, check out the American Diabetes Association Web site
• Medication—there are many drugs out there that can get your blood sugar levels under control. These drugs stimulate the pancreas, the organ that produces insulin, to make more insulin. In turn, this extra insulin can reduce the amount of sugar in your blood. If these drugs are unsuccessful in controlling your diabetes, talk to your healthcare provider about other medications that may work for you