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Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy

Christine A Wanke, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Allyson Bloom, MD


Prior to the availability of antiretroviral therapy, severe wasting and decreased levels of cholesterol were common metabolic abnormalities described in advanced AIDS [1]. With the introduction of effective antiretroviral therapy, descriptions of patients with body shape abnormalities, such as central fat accumulation and peripheral fat loss emerged [2,3]. The term "HIV-associated lipodystrophy syndrome" was coined, but it soon became clear that there was not a single syndrome, that some patients have pure lipoatrophy, others have fat accumulation which may present in a variety of ways, and a subset of patients have a mixed picture of both morphologic features [4-9]. Thus, it is more valid to consider the individual components separately. These morphologic abnormalities can also be associated with disorders in glucose and lipid metabolism [10-12].

Risk factors, clinical manifestations, and diagnosis of HIV-associated lipodystrophy will be discussed here. The management and treatment of these patients is discussed elsewhere. (See "Treatment of HIV-associated lipodystrophy".)

The association between lipodystrophy and metabolic abnormalities is also discussed briefly in this topic. Additional detail on the epidemiology and management of dyslipidemia and disordered glucose metabolism in HIV-infected patients is found elsewhere. (See "Epidemiology of cardiovascular disease and risk factors in HIV-infected patients" and "Management of cardiovascular risk (including dyslipidemia) in the HIV-infected patient".)


Controversy exists about how frequently the lipodystrophy syndrome occurs, with estimates ranging from 10 percent to more than 80 percent [13-16]. The wide variation in prevalence may be partly related to differences in definitions or methodology (eg, patient report versus objective measurements) as well differences in host factors, including geography, age, genetics, lifestyle factors, and specific antiretroviral use and duration of treatment [17-19].

Moreover, lipoatrophy and fat accumulation appear to be different syndromes with different risk factors and differing prevalences. This point was well illustrated in one study of 452 HIV-infected patients who were followed over one year to assess risk factors for progression of morphologic abnormalities [17]. Lipoatrophy was defined as a triceps skin-fold measurement less than the 10th percentile in the National Health and Nutrition Examination Survey for sex and age. Fat accumulation was defined as a waist-to-hip ratio of >0.95 for men and of >0.85 for women as a surrogate for intra-abdominal fat. The study demonstrated the following:


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Literature review current through: Sep 2016. | This topic last updated: Jun 23, 2015.
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