Tien Phyllis C, Grunfeld Carl
Department of Medicine, University of California, San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California 94121, USA.
Curr Opin Infect Dis. 2004 Feb;17(1):27-32. doi: 10.1097/00001432-200402000-00005.
The prevalence of lipodystrophy in HIV infection reported in the early literature has varied widely due in part to the different methods used in assessing and defining lipodystrophy in studies. There remains a lack of clarity regarding whether the peripheral lipoatrophy and central lipohypertrophy initially described in HIV infection are a result of separate mechanisms or a single mechanism. We review the current methods used to assess and define lipodystrophy in HIV infection; the prevalence and incidence of lipodystrophy reported in the recent HIV literature; and future directions in elucidating the morphologic changes associated with HIV infection.
Different methods of assessing and defining lipodystrophy continue to lead to varying prevalence and incidence rates in recent large cross-sectional and prospective studies. Recent studies that include a predominantly HIV-uninfected comparison group and utilize bi-directional surveys to describe fat loss and fat gain in both peripheral and central body sites suggest that there is an HIV-associated lipoatrophy that affects both peripheral and central sites. In one study that used objective measures to quantify fat such as magnetic resonance imaging, HIV-associated subcutaneous lipoatrophy appeared to predominate when compared with a healthy control group.
Peripheral and central lipoatrophy affecting subcutaneous fat is emerging as the dominant morphologic change associated with HIV infection when compared with those without known HIV infection. Studies of lipodystrophy in HIV infection should focus on lipoatrophy using direct measures of fat when possible.
早期文献报道的HIV感染中脂肪代谢障碍的患病率差异很大，部分原因是研究中评估和定义脂肪代谢障碍的方法不同。HIV感染中最初描述的外周脂肪萎缩和中心性脂肪肥大是由单独的机制还是单一机制引起的，目前仍不明确。我们综述了目前用于评估和定义HIV感染中脂肪代谢障碍的方法；近期HIV文献报道的脂肪代谢障碍的患病率和发病率；以及阐明与HIV感染相关的形态学变化的未来方向。
在最近的大型横断面和前瞻性研究中，评估和定义脂肪代谢障碍的不同方法继续导致患病率和发病率有所不同。最近的研究包括一个主要为未感染HIV的对照组，并利用双向调查来描述外周和中心身体部位的脂肪减少和脂肪增加，结果表明存在一种与HIV相关的脂肪萎缩，它会影响外周和中心部位。在一项使用磁共振成像等客观测量方法来量化脂肪的研究中，与健康对照组相比，HIV相关的皮下脂肪萎缩似乎更为明显。
与未感染HIV的人相比，影响皮下脂肪的外周和中心脂肪萎缩正成为与HIV感染相关的主要形态学变化。HIV感染中脂肪代谢障碍的研究应尽可能使用直接的脂肪测量方法来关注脂肪萎缩。
