This is the first study where HIV-associated body composition changes are described in a Scandinavian cohort. All HIV-positive patients living in Oslo who attended our outpatient clinic (n = 407) were invited to participate. 308 patients (78%) were included. Lipodystrophy (LD) prevalence was 37.3% in patients on antiretroviral therapy (ART+) compared to 10.9% in patients without ART (p < 0.001). Prominent veins and combined fat atrophy/accumulation were exclusively found in the ART+ group. Determinants of prominent veins were skin fold thickness, duration of nucleoside reverse transcriptase inhibitor treatment, duration of protease inhibitor treatment and current use of stavudine. When patients with and without LD were compared, breast circumference was 10.6 cm larger in LD+ women than in LD- women (p = 0.003). Chest pain was reported in 26.5% of LD+ compared to 3.9% (p < 0.001) of LD- patients. This may be associated with an increased level of creatin kinase in LD+ compared to LD- patients (161 +/- 179 U/I vs 102 +/- 68, p = 0.004). Eight years after HIV diagnosis 59.1% of the patients with LD had a regular job and 59.4% reported no or small problems with ART.