HIV-associated lipodystrophy - a new metabolic syndrome

Abstract

Human immunodeficiency virus (HIV) associated lipodystrophy may affect up to half or even more HIV-infected patients receiving antiretroviral therapy. However, a simple practical definition for this condition is still lacking. Features of lipoatrophy and lipohypertrophy may be seen in this condition. Intrinsic host factors and disease status, as well as treatment duration and type, probably play key roles in the aetiology. Several metabolic abnormalities such as dyslipidaemia and insulin resistance have been commonly reported in these patients. Most attempts to improve or reverse abnormal fat distribution have so far only shown modest success. Therefore, choosing optimal antiretroviral therapy is vital. There are too few reasons to support widespread use of rosiglitazone and metformin in these patients except on an individual basis. However, lipid lowering agents should be considered in the treatment of severe hypertriglyceridaemia and elevated low-density lipoprotein-cholesterol or a combination of both as lipid abnormalities are commonly seen in thesepatients. Advances in plastic surgery are attractive treatment options as they give immediate results.