The term HIV-associated lipodystrophy typically refers to changes in fat distribution that are often associated with metabolic abnormalities, including dyslipidemia and insulin resistance . Specifically, patients with lipoatrophy have loss of subcutaneous fat, most noticeably in the limbs, face, and/or buttocks areas. Patients with fat accumulation have gain of visceral fat in the abdomen and may have dorsocervical fat pad enlargement (buffalo hump) and breast enlargement.
Patients may present with lipoatrophy, fat accumulation, or a combination of the two . Since potential management differs depending on the nature of the change in fat, lipoatrophy and fat accumulation will be discussed separately after a general consideration of the rationale for treating these disorders.
The treatment of HIV-associated lipodystrophy will be reviewed here. The epidemiology, clinical manifestations, and diagnosis of lipodystrophy are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy".)
RATIONALE FOR TREATMENT
There are multiple reasons to consider treating HIV-associated lipodystrophy, as there are several potential benefits beyond pure cosmesis.
●Metabolic derangements associated with lipodystrophy (dyslipidemia and abnormal glucose metabolism) may predispose patients to cardiovascular disease. Behavioral and medical interventions to address HIV-associated lipodystrophy have the potential to favorably affect these metabolic parameters and ultimately reduce the risk of atherosclerosis and diabetes mellitus. (See "Epidemiology, clinical manifestations, and diagnosis of HIV-associated lipodystrophy".)