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He bought clothes just to cover it up. He was constantly monitoring his posture, hoping to minimize its appearance. But he wasn't able to hide it for long. Someone approached Andy Ansell in his church, pointed at his protruding midsection, and asked, "Are you trying to put on weight?"
HIV-positive for more than two decades, the 42-year-old Minneapolis resident was no stranger to the effects of lipodystrophy -- a side effect in which fat is redistributed throughout the body -- which is caused by certain antiretroviral medications and by the virus itself, not to mention the effects of aging seen in HIVers as pharmaceutical advances are allowing them to live longer.
Ansell had experienced the appearance of pronounced veins on his legs and arms for years. Then, a long convalescence after a cycling accident two years ago left him out of shape and overweight. Twenty extra pounds on his 5-foot-4 frame sank right to his midsection, giving him the distended look that some call "Crix belly," so called after one of the medications that can be major culprits for "lipo" side effects.
"I was like, I'm healthy, but I still have that outward, visible appearance of somebody that has HIV," he says. "While there's nothing wrong with that, it still makes you feel -- no matter how healthy you are -- like there's something wrong with you."
Ansell's doctor told him that no magic pill or procedure could do away with his unwanted belly. The best hope lay in diet and exercise, although there would be no guarantees. At the time, Ansell's commitment to physical fitness was sporadic. Meals were also "hit or miss," he says, with sugar playing a large role in his diet. He decided to make a change.
Ansell switched to eating small meals every three hours. He began to avoid packaged, processed foods and to eat lots of fruits and vegetables, lean protein sources, and whole grains.
"It's not that it's a diet," he says of the tack he took. "It's really more of a lifestyle change."
He also hits the gym like it's going out of style. This includes cardio workouts five days a week on a stationary bicycle and free weights three times a week as well as yoga and abdominal classes. Within six weeks he began to notice the changes to his body.
"I first noticed it," he says, "because my clothes started fitting differently. My pants started to fit again! That was pretty significant. I started to feel -- I hate saying this because it makes it sound like being positive is 'not normal,' but I started to feel normal."
After three months the changes to Ansell's body were dramatic. And today, he's down to 145 pounds and proudly sporting a six-pack.
"I feel great!" he says. "While I'm not ashamed to have HIV, it pisses me off when HIV impacts my life in a negative way. And the body changes were always a reminder of that. Now I really feel like -- I don't want to say victorious, but it really is an experience of 'Screw you, HIV! I know you're in there, but you're not going to take more from me than you've already taken.'"
When researchers at the University of Texas at Austin conducted a review of studies concerning HIV and physical activity, they found that HIVers consistently cite exercise as their most important coping mechanism for dealing with both the virus and side effects of antiretrovirals. So the UT team hoped to prove that exercise can improve quality of life among HIVers. And indeed it can, they found. Not only is some sort of physical fitness routine safe for most people living with the virus, but even moderate exercise has been consistently shown to increase muscular strength and endurance, build muscle, shed fat, and increase overall physical functioning in people living with the virus.
"We see our mission as to preach the gospel that people need to be physically active," says Gregory A. Hand, Ph.D., MPH, the associate dean of academic affairs for the Arnold School of Public Health at the University of South Carolina and an expert on the importance of exercise for HIVers. "They need to watch their diet, and they need to be trying to do healthy lifestyle activities that can affect people with HIV as well as healthy individuals. There's no reason why being infected with HIV should affect your lifestyle in terms of trying to do healthy activities."
For some, though, side effects of medications threaten to keep them away from the gym. But to the determined, such stumbling blocks are only in place to be thrown aside.
Annie Elmer, a physical trainer from Cottage Grove, Minn., who has a love of the outdoors, was on her dream vacation in 2006: a backpacking trip through Montana's Glacier National Park. On the morning of a 19-mile day hike she was having so many gastrointestinal problems that she could hardly keep down her breakfast. Still, she refused to let the symptoms rob her of a special day.
"My stomach hurt for the first seven miles," the 50-year-old recalls. "I would have to sit down, and I would just bawl with frustration that my body couldn't do what I know it can do. The year before, I wouldn't get winded or anything. Then, toward the top of the hike I prayed to God, and instantly the pain was just gone. I was able to have the rest of the day be a good day."
Los Angeles resident Arlene Frames, like Ansell, is hoping to win the battle against lipodystrophy through diet and exercise. The 49-year-old grandmother likes to kick-start her day with a cardio workout. But nausea often threatens to prevent her from getting her plan into gear.
"I've been through some pretty bad side effects on medication," she says. The effects can be so disorienting that sometimes "I don't know how I even drove to the gym," she adds. "But no matter how bad I would feel, I knew if I could just get to the gym and be there for the first 20 minutes and work out, then after I make it over that hump, I would feel so good for the rest of the day. It's remarkable."
Some form of regular exercise can have yet another -- even if intangible -- bonus besides helping to ease the side effects of medications and to improve endurance. Studies have shown that exercise can be a potent antidote to the symptoms of depression, which is a common ailment that afflicts many HIVers. And Frames is quick to attest how her workouts have improved her quality of life.
"Exercise helps everything," Frames says of her workouts. "It helps my emotional state of being, and it helps my physical state of being -- and actually my spiritual state of being. AIDS is bad enough, but it can be beaten. It can be conquered."
Whether the virus itself can be kept at bay as a result of a healthy lifestyle is a matter of scientific mystery. So far, no research has been able to prove that diet and exercise can lower a viral load or increase a T-cell count. Hand says the lack of proof can be blamed on poorly designed studies. His group at the University of South Carolina hopes to conduct a large clinical trial on the matter.
For someone like Kaijson Noilmar, though, the proof is in the pudding. "My numbers -- in regard to my HIV -- were the best when I was in the best shape," says the 33-year-old former college athlete who is now a business consultant in Renton, Wash. His weight has been on a yo-yo cycle over the past few years. "The more in shape I am, the lower my body-fat percentage is, and the better my numbers are going to be."
Ansell agrees. "My T-cell count is better than it's ever been in 20 years of being HIV-positive," he says. "My cholesterol and lipid profile is virtually normal for the first time in many, many years, and my doctor attributes that to diet and exercise."
"A lot has been said about what the medications do to our body -- cholesterol and bodily changes, for example," Ansell continues, "but I think that, as HIV-positive people, we have to be responsible for our lifestyle, and our lifestyle contributes to all of those factors."
How does he feel knowing that he is winning the battle against HIV thanks to his own proactive attitude? "It's just another one of those moments that reinforces that I can do anything," Ansell says. "A person's attitude is everything. If you think it's possible, then you're going to do it."