Recognizing Hard Belly*

Hard Belly is fat located deep within the abdomen. This is also known as abdominal visceral fat.1,2

  • This type of fat is a deep layer of hard-feeling fat that surrounds the abdominal organs.1,2
  • It differs from regular fat (subcutaneous fat), which is found just beneath the skin.1,2

Hard Belly is a hard fat. It feels firmer than regular fat and it may be hard to manage with diet and exercise alone.3,4

Hard Belly can be difficult for patients to accurately describe and often presents as general weight gain or obesity. Talk to your patients about what they’re feeling and conduct a physical exam to determine if they may be a candidate for treatment.

Simple techniques to check for Hard Belly include5,6:

  • Palpating the abdomen for firmness
  • Measuring waist circumference
  • Calculating waist-to-hip radio (waist circumference/hip circumference)

Indicators of Hard Belly:

*Also known as excess abdominal fat.

†Based on inclusion criteria in clinical trials for tesamorelin for injection.

Confronting the Challenge of Hard Belly

The pathogenesis of increased excess abdominal fat in patients with HIV appears to be due to multiple factors, including3,5,7:
Hard Belly in people with HIV may be associated with a variety of health issues and elevated mortality risk.4,7,8
Many patients who are treated for HIV have lipodystrophy, including excess abdominal fat or Hard Belly, i.e. the build up of excess fat around the stomach and other organs in the abdomen area. This is similar to Buffalo Hump, i.e. the buildup of fat at the back of the neck.9,10

References: 1. Carleir RY, de Truchis P, Ronze S, et al. MRI of intra-abdominal fat and HIV-associated lipodystrophy: a case review. J Radiol. 2007;88:947-955. 2. Sethi JK, Vidal-Pulg AJ. Adipose tissue function and plasticity orchestrate nutritional adaptation. J Lipid Res. 2007;48:1253-1262. 3. Falutz J. Management of fat accumulation in patients with HIV infection. Curr HIV/AIDS Rep. 2011:8(3):200-208. 4. Carter M, Hughson G. Lipodystrophy. http://www.aidsmap.com/lipodystrophy/page/1045065/. Accessed April 28, 2017. 5. National Institutes of Health: AIDS info: guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. April 8, 2015. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf. Accessed April 28, 2017. 6. Shuster A, Patlas M, Pinthus JH, et al. The clinical importance of visceral adiposity: a critical review of methods for visceral adipose tissue analysis. Br J Radiol. 2012;85(1009):1-10. 7. Brown TT. Approach to the human immunodeficiency virus-infected patient with lipodystrophy. J Clin Endocrinol Metab. 2008;93(8):2937-2945. 8. Scherzer R, Heymsfield SB, Lee D, et al. Decreased limb muscle and increased central adiposity are associated with 5-year all-cause mortality in HIV infection. AIDS. 2011;25(11):1405-1414. 9. McComsey GA, Kitch D, Sax PE, et al. Peripheral and central fat changes in subjects in randomized to abacavir-lamivudine or tenofovir-emtricitabine with atazanavir-ritonavir or efavirenz: ACTG study A5224s. Clin Infect Dis. 2011;53(2):185-196. 10. Chow D, Day L, Souza S, et al. Metabolic complications of HIV therapy. IAPAC Mon. 2006;12(9):302-317.