Doucas Gabriel, Liakos Dimitri, Koonin Sheree Debbie
Private Practice Linksfield Clinic, Johannesburg, South Africa.
Department Plastic Surgery, University of Witwatersrand, Johannesburg, South Africa.
Plast Reconstr Surg Glob Open. 2020 Oct 29;8(10):e3171. doi: 10.1097/GOX.0000000000003171. eCollection 2020 Oct.
One of the adverse effects of antiretroviral (ARV) drugs in the treatment of human immunodeficiency virus is lipodystrophy, which is often associated with metabolic complications such as hyperlipidemia, increased cardiovascular risk factors, and altered body fat distribution. This is characterized by a dorsal hump, hypermastia, or abdominal pannus deformity. The reasons for corrective surgery are aesthetic, psychosocial, and medical benefits.
This is a prospective study investigating 52 consecutive patients with ARV-induced lipodystrophy syndrome referred for surgical correction (liposuction for dorsal hump, abdominoplasty for increased abdominal pannus, and bilateral breast reduction for hypermastia). Fasting serum lipograms, including cholesterol, triglycerides, high-density cholesterol (HDL), and low-density cholesterol (LDL), were taken preoperatively and repeated 9-12 months post lipectomy/liposuction.
A subgroup of 35 patients with deranged preoperative triglycerides ( = 0.004), cholesterol ( = 0.001), and or LDL cholesterol ( = 0.017) showed a statistically significant ( < 0.05) decrease in postoperative levels. If preoperative lipogram values were normal, there is no statistically significant reduction postoperatively.
In ARV-associated lipodystrophy, when the preoperative fasting lipograms are deranged, then after surgical correction there is a statistically significant reduction in triglyceride, total cholesterol, and LDL levels. This influences their cardiovascular risk profile, mortality, morbidity, and quality of life.
抗逆转录病毒（ARV）药物治疗人类免疫缺陷病毒时的不良反应之一是脂肪代谢障碍，其常与高脂血症、心血管危险因素增加及体脂分布改变等代谢并发症相关。其特征为背部隆起、乳房肥大或腹部皮肤松弛畸形。进行矫正手术的原因包括美观、心理社会及医学益处。
这是一项前瞻性研究，调查了连续52例因ARV诱导的脂肪代谢障碍综合征而接受手术矫正的患者（对背部隆起进行抽脂术，对腹部皮肤松弛增加进行腹壁成形术，对乳房肥大进行双侧乳房缩小术）。术前采集空腹血清脂质谱，包括胆固醇、甘油三酯、高密度胆固醇（HDL）和低密度胆固醇（LDL），并在抽脂/吸脂术后9 - 12个月重复采集。
35例术前甘油三酯（ = 0.004）、胆固醇（ = 0.001）和/或LDL胆固醇（ = 0.017）紊乱的患者亚组术后水平有统计学显著下降（ < 0.05）。如果术前脂质谱值正常，术后则无统计学显著降低。
在ARV相关的脂肪代谢障碍中，当术前空腹脂质谱紊乱时，手术矫正后甘油三酯、总胆固醇和LDL水平有统计学显著降低。这会影响其心血管风险状况、死亡率、发病率和生活质量。
