Antiretroviral therapy: new solutions bring new problemsBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7384.337 (Published 08 February 2003) Cite this as: BMJ 2003;326:337
All rapid responses
Antiretroviral drugs used to manage HIV have been associated with a
range of unwanted metabolic and morphological side effects1. In
particular, lipodystrophy, the disposition of intra-abdominal and dorso-
cervical (“buffalo hump”) fat and the atrophy of peripheral fat, can be
psychologically distressing to patients. Research has shown that people
suffering from lipodystrophy feel twice as likely to be recognised as HIV-
positive as people without lipodystrophy2. People living with HIV but
without lipodystrophy indicate that lipodystrophy would erode their
quality of life by 20%2. Subjects are willing to take a mean value of 13%
additional risk of death in order to avoid the disfigurement caused by
In a recent letter to the BMJ, Atkins, Eccles and Butler3 make a
cautious argument for the use of plastic surgery to correct some
morphological symptoms in some cases. I am writing to highlight a growing
body of research that suggests that exercise can be an effective
complementary therapeutic measure.
Although the effects are not immediate, a well-designed exercise
intervention, conducted in a safe and supervised environment can bring
about considerable benefits to the patient. Progressive resistance
exercise has shown a significant decline in abdominal obesity4, 5 and an
increase in lean body mass6. Resistance exercise can reduce
hypertriglyceridemia in HIV-infected men suffering from lipodystrophy7.
Exercise can also improve functional capacity and also facilitate social
interaction, which has a major impact on patients’ quality of life8.
1 Oette M, Juretzko P, Kroidl A, Sagir A, Wettstein M, Siegrist J,
Haussinger D. Lipodystrophy and self-assessment of well-being and physical
appearance in HIV-positive patients. AIDS Patient Care and STD 2002; 12
2 Lenert LA, Feddersen M, Sturley A & Lee D. Adverse effects of
medications and trade-offs between length of life and quality of life in
human immunodeficiency virus infection. American Journal of Medicine
2002; 113: 229-232.
3 Atkins JL, Eccles S, Butler PEM. Antiretroviral therapy: new
solutions bring new problems. BMJ 2003; 326: 337. (8 January).
4 Roubenoff R, Weiss L, McDermott A, Heflin T, Cloutier GJ, Wood M
& Gorbach S. A pilot study of exercise training to reduce trunk fat in
adults with HIV-associated fat redistribution. AIDS 1999; 13: 1373-1375.
5 Roubenoff R, Schmitz H, Bairos L, Layne J, Potts E, Cloutier GJ
& Denry F. Reduction of abdominal obesity in liodystrophy associated
with human immunodeficiency virus infection by means of diet and exercise:
Case report and proof of principle. Clinical Infectious Diseases 2002; 34:
6 Roubenoff R, McDermott A, Weiss L, Suri J, Wood M, Bloch R &
Gorbach S. Short-term progressive resistance training increases strength
and lean body mass in adults infected with human immunodeficiency virus.
AIDS 1999; 13: 231-239.
7 Yaresheski KE, Tebas P, Stanerson B, Claxton S, Marin D, Bae K,
Kennedy M, Tantisiriwat W & Powderly WG. Resistance exercise training
reduces hypertriglyceridemia in HIV-infected men treated with antiviral
therapy. Journal of Applied Physiology 2001; 90: 133-138.
8 Roubennoff R & Wilson IB. Effects of resistance training on
self-reported physical functioning in HIV-infection. Medicine and Science
in Sports and Exercise 2001; 33 (11): 1811-1817.
Competing interests: No competing interests