HIV-associated lipodystrophy

Classification	MeSH: D039682;
External resources	eMedicine: article/1082199;

HIV-associated lipodystrophy
HIV-associated lipodystrophy
Other names: Lipodystrophy in HIV-infected patients (LD-HIV)
	Facial lipoatrophy associated with HIV.

HIV-associated lipodystrophy is a type of lipomatosis.^[1] It is characterized by loss of subcutaneous fat associated with infection with HIV.^[2]^[3]^: 497

Signs and symptoms

HIV-associated lipodystrophy commonly presents with fat loss in face, buttocks, arms and legs.^{[citation needed]}

There is also fat accumulation in various body parts. Patients often present with "buffalo hump"-like fat deposits in their upper backs. Breast size of patients (both male and female) tends to increase. In addition, patients develop abdominal obesity.^{[citation needed]}

Cause

The exact mechanism of HIV-associated lipodystrophy is not fully elucidated. There is evidence indicating both that it can be caused by anti-retroviral medications and that it can be caused by HIV infection in the absence of anti-retroviral medication.^[4]

Evidence implicating anti-retroviral medications

On the one hand, lipodystrophy seems to be mainly due to HIV-1 protease inhibitors. Interference with lipid metabolism is postulated as pathophysiology. Also, the development of lipodystrophy is associated with specific nucleoside reverse transcriptase inhibitors (NRTI). Mitochondrial toxicity is postulated to be involved in the pathogenesis associated with NRTI.^[5]

Evidence implicating HIV infection alone

On the other hand, there is evidence that HIV-1 infection on its own contributes to the development of the lipodystrophic phenotype by interfering with some key genes of adipocyte differentiation and mitochondrial function on patients which have not received antiretroviral treatment.^[6]

Diagnosis

The diagnosis of HIV-associated_lipodystrophy is based on :^[2]

BMI
Characteristic physical appearance
Lipid profile
Glucose tolerance

Management

GHRH analogs such as tesamorelin can be used to treat HIV-associated lipodystrophy.^{[citation needed]}

Prognosis

Reversion of lipodystrophy does not occur after withdrawal of protease inhibitors.^[5]

References

↑ WHO Classification of Tumours Editorial Board, ed. (2020). "1. Soft tissue tumours: Lipomatosis". Soft Tissue and Bone Tumours: WHO Classification of Tumours. Vol. 3 (5th ed.). Lyon (France): International Agency for Research on Cancer. pp. 16–17. ISBN 978-92-832-4503-2.
↑ ^2.0 ^2.1 Guzman, Nilmarie; Vijayan, Vini (2022). "HIV-associated Lipodystrophy". StatPearls. StatPearls Publishing. Archived from the original on 8 March 2022. Retrieved 23 April 2022.
↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.
↑ Saavedra, Arturo; Roh, Ellen K.; Mikailov, Anar (2023). "27. Viral diseases of skin and mucosa". Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (9th ed.). New York: McGraw Hill Professional. p. 748. ISBN 978-1-264-27801-5. Archived from the original on 2024-09-29. Retrieved 2025-10-11.
↑ ^5.0 ^5.1 Martinez E, Mocroft A, García-Viejo MA, et al. (February 2001). "Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study". Lancet. 357 (9256): 592–8. doi:10.1016/S0140-6736(00)04056-3. PMID 11558485. S2CID 33325225.
↑ Giralt M, Domingo P, Guallar JP, et al. (2006). "HIV-1 infection alters gene expression in adipose tissue, which contributes to HIV- 1/HAART-associated lipodystrophy". Antivir Ther. 11 (6): 729–40. PMID 17310817.

External links

[WHOblue2020-1] WHO Classification of Tumours Editorial Board, ed. (2020). "1. Soft tissue tumours: Lipomatosis". Soft Tissue and Bone Tumours: WHO Classification of Tumours. Vol. 3 (5th ed.). Lyon (France): International Agency for Research on Cancer. pp. 16–17. ISBN 978-92-832-4503-2.

[Guzman2022-2] 2.0 ^2.1 Guzman, Nilmarie; Vijayan, Vini (2022). "HIV-associated Lipodystrophy". StatPearls. StatPearls Publishing. Archived from the original on 8 March 2022. Retrieved 23 April 2022.

[Andrews-3] James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 978-0-7216-2921-6.

[Fitzpatrick2023-4] Saavedra, Arturo; Roh, Ellen K.; Mikailov, Anar (2023). "27. Viral diseases of skin and mucosa". Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology (9th ed.). New York: McGraw Hill Professional. p. 748. ISBN 978-1-264-27801-5. Archived from the original on 2024-09-29. Retrieved 2025-10-11.

[martinez-5] 5.0 ^5.1 Martinez E, Mocroft A, García-Viejo MA, et al. (February 2001). "Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study". Lancet. 357 (9256): 592–8. doi:10.1016/S0140-6736(00)04056-3. PMID 11558485. S2CID 33325225.

[giralt-6] Giralt M, Domingo P, Guallar JP, et al. (2006). "HIV-1 infection alters gene expression in adipose tissue, which contributes to HIV- 1/HAART-associated lipodystrophy". Antivir Ther. 11 (6): 729–40. PMID 17310817.

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Classification	MeSH: D039682
External resources	eMedicine: article/1082199