HIV-Associated Lipodystrophy - A New Metabolic Syndrome
Human immunodeficiency virus (HIV) associated lipodystrophy may affect up to half or even more HIV-infected patients receiving antiretroviral therapy. However, a simple practical definition for this condition is still lacking. Features of lipoatrophy and lipohypertrophy may be seen in this condition. Intrinsic host factors and disease status, as well as treatment duration and type, probably play key roles in the aetiology. Several metabolic abnormalities such as dyslipidaemia and insulin resistance have been commonly reported in these patients. Most attempts to improve or reverse abnormal fat distribution have so far only shown modest success. Therefore, choosing optimal antiretroviral therapy is vital. There are too few reasons to support widespread use of rosiglitazone and metformin in these patients except on an individual basis. However, lipid lowering agents should be considered in the treatment of severe hypertriglyceridaemia and elevated low-density lipoprotein-cholesterol or a combination of both as lipid abnormalities are commonly seen in these patients. Advances in plastic surgery are attractive treatment options as they give immediate results.

HAART has greatly reduced the morbidity and mortality of patients with AIDS. However, a significant number of AIDS patients on HARRT develop characteristic changes in body fat distribution referred to as lipodystrophy syndrome. Features of lipodystrophy syndrome include lipoatrophy of periorbital and temporal regions of the face, limbs and buttocks. This can be accompanied by an accumulation of visceral fat. The resultant lipohypertrophy may be found as dorsocervical fat pads (buffalo hump) and in the submental region. Fat accumulation may also occur in the liver. Whether gynecomastia is a feature is unclear. Biochemically, these patients tend to have increased TG's, TC, LDL-C, and extremely low HDL-C. If untreated, these patients develop complications of metabolic syndrome, due to drug-induced insulin resistance, with increased risk of IGT or type 2 diabetes, dyslipidaemia and premature cardiovascular complications. This article is based on two case reports to illustrate the nature of the problem within clinical practice. These case reports and discussion add further to the review by Wierzbicki et al. published in this issue of the British Journal of Diabetes and Vascular Disease.