Lipodystrophy, or fat redistribution syndrome, is a disorder of the adipose (fatty) tissues that causes changes in the body shape due to loss and/or accumulation of body fat. Metabolic changes may also occur, causing increased resistance to insulin and abnormally high levels of cholesterol and triglycerides.
HIV-associated lipodystrophy is a syndrome that occurs in individuals who have HIV and are receiving antiretroviral therapy (particularly protease inhibitors). On average, HIV-associated lipodystrophy develops 18 months after initiation of therapy.
HIV-associated lipodystrophy is a progressive disease. The severity of the condition is directly proportional to the patient's age, duration of disease and length of protease inhibitor therapy.
Current studies show that this syndrome occurs in 2-60% of patients who are HIV positive. A recent five-year retrospective cohort study found that 13% of patients who were HIV-positive and treated with protease inhibitors developed lipodystrophy. An incidence rate of 4% has been reported in HIV-positive patients who are not receiving antiretroviral therapy.
Women are almost twice as likely to develop lipodystrophy than men. The increased risk is associated with an increased body mass index (BMI). Women are more likely to report fat accumulation in the abdomen and breasts, while men are more likely to experience fat depletion from the face and extremities.
HIV-associated lipodystrophy progressively worsens as treatment with protease inhibitors continues. However, discontinuing protease inhibitor therapy may lead to regression of the disease. Both lipohypertrophy and lipoatrophy have been treated with human growth hormone, naltrexone, anabolic steroids and a combination of dehydroepiandrosterone (DHEA) and cyclooxygenase inhibitors.
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