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.
Wierzbicki AS , Purdon SD, Hardman TC et al. Clinical aspects of the management of HIV Lipodystrophy. Br J Diabetes & Vasc Dis2008;8:113-19.
2.
Milinkovic A. , Martinez E.Current perspectives on HIV-associated lipodystrophy syndrome. J Antimicrob Chemother2005;56:6-9.
3.
Carr A., Samaras K., Burton S. et al. A syndrome of peripheral lipodystrophy, hyperlipidemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS1998;12:F51-F58.
4.
Heath K., Hogg RS, Chan KJ et al. Lipodystrophy-associated morphological, cholesterol and triglyceride abnormalities in a population-based HIV/AIDS treatment database. AIDS2001;15:231-9.
5.
Friis-Moller N., Weber R., Reiss P. et al. Cardiovascular disease risk factors in HIV patients - association with antiretroviral therapy. Results from the DAD study. AIDS2003;17:1179-93.
6.
Wanke C.Editorial comment: a case definition for HIV lipodystrophy- a work in progress . AIDS Read2003;13:492-3.
7.
Carr A., Emery S., Law M., Puls R., Lundgren JD, Powderly WGHIV Lipodystrophy Case Definition Study Group. Lancet2003;361:726-35.
8.
Saint-Marc T. , Partisani M., Poizot-Martin L. et al. Fat distribution evaluated by computed tomography and metabolic abnormalities in patients undergoing antiviral therapy: preliminary results of the LIPOCO study. AIDS2000;14:37-49.
9.
Enzi G., Gasparo M., Biondetti PR et al. Subcutaneous and visceral fat distribution according to sex, age and overweight, evaluated by computed tomography. Am J Clin Nutr1986;44:739-46.
10.
Asensi V., Martin-Roces E., Carton JA et al. Perirenal fat diameter measured by echography could be an early predictor of lipodystrophy in HIV type 1 infected patients receiving highly active antiviral therapy. Clin Infect Dis2004;39:240-7.
11.
Martinez E. , Bianchi L., Garcia MA et al. Sonographic assessment of regional fat in HIV infected persons. Lancet2000;3 R 56:1412-13.
12.
Wanke CAEpidemiological and clinical aspects of metabolic complications of HIV infection: the fat redistribution syndrome. AIDS1999;
13.
:1287-93. 13. Nolan D., Pace C.Potential roles for uncoupling proteins in HIV lipodystrophy. Mitochondrion2004;4:185-191.
14.
Lichtenstein KARedefining lipodystrophy syndrome: risks and impact on clinical decision making. J Acquir Immune Defic Syndr2005; 39:395-400.
15.
Sekhar RV, Jahoor F., Pownall HJ et al. Severely dysregulated disposal of postprandial triacylglycerols exacerbates hypertriacylglycerolaemia in HIV lipodystrophy syndrome. Am J Clin Nutr2005;81:1405-10.
16.
Sekhar RV, Jahoor F., White AC et al. Metabolic basis of HIV lipodystrophy syndrome. Am J Physiol Endocrinol Metab2002; 283:E332-E337.
17.
Johnson JA, Albu JB, Engelson ES et al. Increased systemic and adipose tissue cytokines in patients with HIV-associated lipodystrophy. Am J Physiol Endocrinol Metab2004;286:E261-E271.
18.
Rietschel P. , Hadigan C., Corcoran C. et al. Assessment of growth hormone dynamics in human immunodeficiency virus-related lipodystrophy . J Clin Endocrinol Metab2001;86:504-10.
19.
Batterham M. , Garsia R., Greenop P. et al. Dietary intake, serum lipids, insulin resistance and body composition in the era of highly active antiretroviral therapy. `Diet FRS Study'. AIDS2000;14:1839-43.
20.
Behrens G., Schmidt RELipodystrophy syndrome. HIV Medicine2005; Chapter 7:283-98. www.HIVMedicine.com
21.
Shlay JC, Visnegarwala F., Bartsch G. et al. Body composition and metabolic changes in antiretroviral naïve patients randomized to didanosine and stavudine vs. abacavir and lamivudine . J Acquir Immune Defic Syndr2005;38:147-55.
22.
Martinez E. , Arnaiz JA, Podzamcer D. et al. Substitution of Nevirapine, Efavirenz or Abacavir for protease inhibitors in patients with human immunodeficiency virus infection. N Engl J Med2003;349:1036-46.
23.
Carr A., Hudson J., Chau J. et al. HIV protease inhibitor substitution in patients with lipodystrophy: randomised, controlled, open-label, multi-centre study. AIDS2001;15:1811-22.
24.
Martin A., Smith DE, Ringland C. et al. Reversibility of lipoatrophy in HIV-infected patients 2 years after switching from a thymidine analogue to Abacavir: the MITOX extension study. AIDS2004;18:1029-36.
25.
Moyle G., Sabin C., Cartledge J. et al. A 48-week, randomized, open-label comparative study of Tenofovir DF vs. Abacavir as substitutes for a thymidine analog in persons with lipoatrophy and sustained virological suppression on HAART. In: Program and Abstracts of the Twelfth Conference on Retroviruses and Opportunistic Infections, Boston, MA, USA, 2005. Abstract 44LB, p.81. Foundation for Retrovirology and Human Health, Alexandria VA, USA.
26.
Gelato MC, Mynarick DC, Quick JL et al. Improved insulin sensitivity and body fat distribution in HIV-infected patients treated with Rosiglitazone: a pilot study. J Acquir Immune Defic Syndr2002; 31:163-70.
27.
Sutinen J., WHakkinen AM, Westerbacka J. et al. Rosiglitazone in the treatment of HAART-associated lipodystrophy - a randomized doubleblind placebo controlled study. Antivir Ther2003;8:199-207.
28.
Carr A., Workman C., Carey D. et al. No effect of Rosiglitazone for treatment of HIV-1 lipoatrophy: randomised, double-blind, placebo-controlled trial. Lancet2004 ;363:429-38.
29.
Mallon P., Sedwell GT, Rogers G. et al. The effect of Rosiglitazone on PPAR-γ expression in human adipose tissue is limited by continued exposure to thymidine NRTI. In: Program and Abstracts of the Twelfth Conference on Retroviruses and Human Health, Alexandria, VA, USA.
30.
Schambelan M., Benson C., Carr A. et al. Management of metabolic complications associated with antiviral therapy for HIV-infection: recommendations of an International AIDS Society-USA Panel. J Acquir Immune Defic Syndr2003;31:257-75.
31.
Kotler DP, Muurahainen N., Grunfeld C. et al. Effects of growth hormone on abnormal visceral adipose tissue accumulation and dyslipidaemia in HIV-infected patients. J Acquir Immune Defic Syndr2004;34:239-52.
32.
Rao A., D'Amico S., Balasubramanyam A. et al. Fenofibrate is effective in treating hypertriglyceridaemia associated with HIV lipodystrophy. Am J Med Sci2004;327:315-18.
33.
Badiou S., Merle De Boever C., Dupuy AM et al. Fenofibrate improves the atherogenic lipid prophile and enhances LDL resistance to oxidation in HIV positive adults. Atherosclerosis2004;172:272-9.
34.
Miller J., Brown D., Amin J. et al. A randomised, double-blind study of gemfibrozil for the treatment of protease inhibitor-associated hypertriglyceridaemia. AIDS2002;16:2195-200.
35.
Ponce-De-Leon S., Iglesias M., Ceballos J. et al. Liposuction for protease inhibitor associated lipodystrophy. Lancet1999;353:1244.
36.
Wolfort FG, Cetrulo CL, Nevarre DRSuction-assisted lipectomy for lipodystrophy syndromes attributed to HIV protease inhibitor use. Plast Reconstr Surg1999;104:1814-20.
37.
Fontdevilla J., Milinkovic A., Martinez E. et al. Treatment of facial lipoatrophy by injection of autologous adipose tissue. Antivir Ther2003; 8:L76.
38.
Serra-Renom JM, Fontdevila J.Treatment of facial fat atrophy related to treatment with protease inhibitors by autologous fat injection in patients with human immunodeficiency virus infection. Plast Reconstr Surg2004;114:551-5.
