By @Londondiaries2

Have you been HIV-positive for several years? Has your waistline gotten increasingly large over time, even while following a healthy diet and exercising? If the answer to both these questions is yes, then you should read on.

Five years ago, I noticed that I was storing fat around my stomach and waistline. Suddenly I was flabbier. I was developing ‘love handles.’ I was 39 at the time. At first, I thought that this could be a consequence of my metabolism slowing down. However, my lifestyle wouldn’t explain the body changes that I was experiencing. As a keen cyclist, gym goer and regular squash player, I’ve always embraced a very active lifestyle and followed a healthy diet. What was happening to my body didn’t make sense to me.

Then, I realised that I was looking at this from the wrong angle. The fact is, I wasn’t gaining any weight. It was the fat distribution in my body that was off. Therefore, I started looking for outside factors that potentially could cause my visceral fat gain, and I began to discuss my concern with other people I knew to be HIV-positive. Once we shared our experiences, it became clear that there was a familiar pattern.

Twelve years on, I still remember what my HIV doctor told me at the time of my diagnosis: “This is not a death sentence. Taking your meds will allow you to grow old and live a normal life. And no, you won’t develop any lipoatrophy, heritage of the old treatment regimens.” It’s all true, and I was relieved. Unfortunately, this was only half the story, as I discovered when I came across a medical study published in February 2019.

As it turned out, the HIV infection itself initiates a first wave of irreversible alterations and inflammation in adipose tissue (which serves as the reservoir for HIV). These changes eventually will affect the natural distribution of fat in the body. The study goes on to state, among other things, that to monitor changes, and where a body scan is not available, patients in a stable condition should have their waist measured every time they have their six months routine checks. In twelve years, I’ve never had my waist measured.

It is only a matter of time before an individual infected with HIV will develop lipo-hypertrophy, aka intra-abdominal visceral fat accumulation, in breasts, the dorsal-cervical region, and under the skin as lipomas. You will look overweight, even if you’re not.

The only possible way to shift or control visceral fat increase is through combined high-intensity aerobic exercises and strength training, which is why it baffles me why HIV doctors don’t discuss this matter with their patients. Possibly, it could be because HIV is a relatively new virus. There is not enough data to understand what it does to an ageing person. However, the right conversation would provide people with the knowledge to make an informed choice on how to keep visceral fat gain under control if they wished to do so.

I believe that out there, we have an HIV-positive ageing population who’s unaware that their expanding waistline is a direct result of being infected with HIV and think that developing a belly is a natural consequence of growing old and being less active. Gay men, in general, have body image issues, more so HIV-positive people, who subconsciously strive to look healthy. A growing belly is not what we want. I wonder how the inability to keep a waistline in check would eventually affect one’s mental health.

Evidence shows that high visceral fat accumulation causes cholesterol. Cholesterol, if untreated, leads to diabetes. There is no data I am aware of to learn how many long term HIV+ people in their twenties, thirties, forties, and over (in the UK and, exponentially, across the world) have already cholesterol or suffer from diabetes, nor we’d know how this would impact HIV medical funding in years to come. Most importantly, no one is having this conversation. 

As it grows older, the HIV-positive population faces a set of problems no one could foresee or anticipate. We are learning as we keep on living into old age, which is why it’s paramount that we listen to our bodies and note what we see and how we feel. It is our responsibility to ask the questions. If we don’t speak up, no one will. We must keep on fighting for us and to honour the millions of people who died. Without them, we wouldn’t be here either. Therefore, if you have identified with what I have discussed, talk about it with your peers, share. There is no shame in being HIV+. In the end, we are all “patient zero,” still seeking hope, answers, and a better life.

Find the source for the study at

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