Lipodystrophy

CLINICAL

• Obesity is defined by body mass index (BMI) ≥30 kg/m². In those with low body mass, BMI ranging from 18.5 to 24.9 kg/m² may represent excess adiposity.[6]
  • Cause is multifactorial and includes imbalance between calories consumed and expended, age, genetics, and microbiome alterations.
  • Adipocyte plays central role in multisystem disease.[3]
• Lipohypertrophy is localized abnormal fat accumulation: central or visceral adipose tissue (VAT), breast fat, dorso-cervical fat pad (buffalo hump) or lipomas.
  • Central adiposity is linked to increased mortality.[9]
    • VAT accumulation, as little as 5%, is associated with metabolic syndrome, diabetes, and cardiovascular disease (CVD).[6]
    • VAT, intrahepatic fat, and epicardial fat are associated with CVD, independent of traditional CVD risk factors.
  • Lipohypertrophy is associated with elevation of inflammatory cytokines.
• Lipoatrophy (LA): peripheral fat loss in face, limbs and buttocks.
  • Consequence of thymidine analog NRTIs: d4T, ZDV. Switching ART prevents progression, but fat recovery slow and likely incomplete.
  • Can be confused with wasting, which is due to HIV disease progression and/or OIs, and includes both muscle and fat loss.
• Lipodystrophy: coexisting lipohypertrophy and lipoatrophy with changes in body fat composition based on anthropomorphic measures of fat distribution, such as waist circumference (WC).
  • Accompanied by metabolic disorders: dyslipidemia, hypertriglyceridemia, low HDL, insulin resistance, and diabetes mellitus.
  • Low frequency (< 5%) with current ART regimens.