II. Pathophysiology
- Occurs in some patients never exposed to Antiretroviral
- Common adverse effect of Anti-Retroviral Therapy
- Occurs in 64% of patients on Protease Inhibitors
- Also occurs with nRTI therapy
III. Signs
- Peripheral Fat Wasting
- Loss of facial fat (e.g. cheeks with deep dimples)
- Loss of subcutaneous fat in the legs
- Redistribution of fat centrally
- Increased abdominal fat (Protease Paunch)
- Gynecomastia
- Neck fat pad hypertrophy (Buffalo hump)
- Seen also in Cushing's Syndrome
- Hyperlipidemia
- Insulin Resistance
IV. Complications
- Pancreatitis
- Metabolic Syndrome equivalent
- Pro-thrombotic state with potential increased risks
- Cerebrovascular Accident (stroke)
- Increased risk of cardiovascular disease
- Mortality may be increased
V. Management
- Low Fat Diet
- HMG CoA Reductase Inhibitors (Statins)
- Fibric Acid Derivatives (Gemfibrozil)
- Recombinant Growth Hormone
- May offer short term benefit in lipohypertrophy
- Liposuction with redistribution to areas of fat loss
- Polylactic acid and Calcium hydroxylapatite injections
- May offer short-term benefit with facial Lipoatrophy
- Consider adjusting Antiretroviral regimen
- Change Protease Inhibitor (Indinavir to Nelfinavir)
- Switch Protease Inhibitor to another Antiretroviral
- Hyperinsulinemia
- Metformin
- Thiazolidinediones (e.g. Rosiglitazone)
- Efficacy and safety in Lipodystrophy is unclear
VI. References
- Lieu (2001) CMEA Medicine Lecture, San Diego
- Hadigan (2001) AIDS Clin Care 13:13-9 [PubMed]
- Hadigan (2000) JAMA 284:472-7 [PubMed]
- Kuwahara (2002) Am Fam Physician 65(7):1405-6 [PubMed]
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Definition (NCI) | A congenital or acquired disorder characterized by abnormal loss or redistribution of the adipose tissue in the body. |
Definition (CSP) | collection of rare conditions resulting from defective fat metabolism and characterized by atrophy of the subcutaneous fat; includes total, congenital or acquired, partial, abdominal infantile, and localized lipodystrophy. |
Definition (MSH) | A collection of heterogenous conditions resulting from defective LIPID METABOLISM and characterized by ADIPOSE TISSUE atrophy. Often there is redistribution of body fat resulting in peripheral fat wasting and central adiposity. They include generalized, localized, congenital, and acquired lipodystrophy. |
Concepts | Disease or Syndrome (T047) |
MSH | D008060 |
ICD9 | 272.6 |
ICD10 | E88.1 |
SnomedCT | 190790002, 190789006, 71325002 |
English | Lipodystrophies, LIPODYSTROPHY, Lipodystrophy NOS, Lipodystrophy [Disease/Finding], lipodystrophy, lipoatrophy, lipodystrophy (diagnosis), Lipodystrophy NOS (disorder), Dystrophy of fatty tissue, Lipodystrophy (disorder), Lipodystrophy, NOS, Lipodystrophy |
French | LIPODYSTROPHIE, Lipodystrophies, Lipodystrophie |
Portuguese | LIPODISTROFIA, Lipodistrofias, Lipodistrofia |
Spanish | LIPODISTROFIA, lipodistrofia, SAI (trastorno), lipodistrofia, SAI, distrofia del tejido graso, lipodistrofia (trastorno), lipodistrofia, Lipodistrofias, Lipodistrofia |
German | LIPODYSTROPHIE, Lipodystrophien, Lipodystrophie |
Italian | Lipodistrofie, Lipodistrofia |
Dutch | lipodystrofie, lipodystrofieën, Dystrofie, lipo-, Lipodystrofie |
Swedish | Lipodystrofi |
Czech | lipodystrofie, Dystrofie tukové tkáně, Lipodystrofie |
Finnish | Lipodystrofia |
Russian | LIPODISTROFIIA, LIPOATROFIIA, ЛИПОАТРОФИЯ, ЛИПОДИСТРОФИЯ |
Japanese | リポジストロフィー, リポジストロフィー |
Croatian | LIPODISTROFIJA |
Polish | Lipodystrofia, Zanik tkanki podskórnej |
Hungarian | Lipodystrophiák, Lipodisztrófia |
Norwegian | Lipodystrofi |
Ontology: Lipoatrophy (C1280433)
Concepts | Disease or Syndrome (T047) |
SnomedCT | 248315005 |
Italian | Lipoatrofia |
Japanese | 脂肪組織萎縮症, シボウソシキイシュクショウ |
Czech | Lipoatrofie |
English | lipoatrophy, Lipoatrophy (disorder), Lipoatrophy |
Hungarian | Lipodystrophia |
Spanish | lipoatrofia (trastorno), lipoatrofia, Lipoatrofia |
Portuguese | Lipoatrofia |
Dutch | lipo-atrofie |
French | Lipo-atrophie |
German | Fettgewebeatrophie |