Lipodystrophy

Lisa A. Spacek, M.D., Ph.D.
Lipodystrophy is a topic covered in the Johns Hopkins HIV Guide.

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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.

-- To view the remaining sections of this topic, please or --

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.

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Last updated: October 19, 2022