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:
●Patients are often distressed by the physical changes in their appearance, especially if they develop facial lipoatrophy. These morphologic abnormalities can have a significant impact on self-esteem .