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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
Howard Libman, MD, FACP


Prior to the availability of effective antiretroviral therapy (ART), severe wasting and decreased levels of cholesterol were common metabolic abnormalities described in advanced acquired immunodeficiency syndrome (AIDS) [1]. With the introduction of effective ART, 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 but rather the co-occurrence of phenotypes that varies from person to person. It may be that some individuals will present with 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 human immunodeficiency virus (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]. The presumption is that the prevalence will be lower with the increased use of newer antiretroviral drugs, but there are few studies looking at prevalence of the syndrome.

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 intraabdominal fat. The study demonstrated the following:

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Literature review current through: Nov 2017. | This topic last updated: Aug 29, 2017.
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