II. Pathophysiology

  1. Occurs in some patients never exposed to Antiretroviral
  2. Common adverse effect of Anti-Retroviral Therapy
    1. Occurs in 64% of patients on Protease Inhibitors
    2. Also occurs with nRTI therapy

III. Signs

  1. Peripheral Fat Wasting
    1. Loss of facial fat (e.g. cheeks with deep dimples)
    2. Loss of subcutaneous fat in the legs
  2. Redistribution of fat centrally
    1. Increased abdominal fat (Protease Paunch)
    2. Gynecomastia
    3. Neck fat pad hypertrophy (Buffalo hump)
      1. Seen also in Cushing's Syndrome
  3. Hyperlipidemia
  4. Insulin Resistance

IV. Complications

  1. Pancreatitis
  2. Metabolic Syndrome equivalent
  3. Pro-thrombotic state with potential increased risks
    1. Cerebrovascular Accident (stroke)
    2. Increased risk of cardiovascular disease
    3. Mortality may be increased

V. Management

  1. Low Fat Diet
  2. HMG CoA Reductase Inhibitors (Statins)
  3. Fibric Acid derivatives (Gemfibrozil)
  4. Recombinant Growth Hormone
    1. May offer short term benefit in lipohypertrophy
  5. Liposuction with redistribution to areas of fat loss
  6. Polylactic acid and Calcium hydroxylapatite injections
    1. May offer short-term benefit with facial Lipoatrophy
  7. Consider adjusting Antiretroviral regimen
    1. Change Protease Inhibitor (Indinavir to Nelfinavir)
    2. Switch Protease Inhibitor to another Antiretroviral
      1. Nevirapine (Viramune)
      2. Efavirenz (Sustiva)
  8. Hyperinsulinemia
    1. Metformin
    2. Thiazolidinediones (e.g. Rosiglitazone)
      1. Efficacy and safety in Lipodystrophy is unclear

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Ontology: Lipodystrophy (C0023787)

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
Japanese リポジストロフィー, リポジストロフィー
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