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]