HIV-Associated Lipodystrophy

HIV-associated lipodystrophy is an undesirable effect of antiretroviral therapy (ART) that occurs due to the redistribution of adipose tissue (see  HIV-Induced Lipodystrophy). The first reports of this condition were in 1997 among people taking ART. HIV-associated lipodystrophy can manifest as two distinct phenotypes: fat accumulation (lipohypertrophy) or fat loss (lipoatrophy). In some patients, the 2 manifestations may coexist as well. Lipoatrophy occurs on the face, buttocks, arms, and legs. In contrast, lipohypertrophy occurs in the truncal areas and manifests as abdominal obesity, mammary hypertrophy, accumulation of fat on the neck, or lipomas. These body image and habitus changes, especially facial lipoatrophy, have been linked to depression, decreased self-esteem, sexual dysfunction, and social isolation and can greatly affect the patient’s quality of life and adherence to ART. Lipodystrophy also contributes to morbidity via the development of insulin resistance, hyperlipidemia, and endothelial dysfunction, which can increase the risk of cardiovascular disease. Therefore, identification and prompt management of HIV-associated lipodystrophy are of utmost importance.