| HIV-associated lipodystrophy | |
|---|---|
| Other names | Lipodystrophy in HIV-infected patients (LD-HIV) |
 | |
| Illustrations of signs of HIV-associated lipodystrophy, such as facial lipoatrophy, abdominal lipohypertrophy, and a "buffalo hump" | |
| Specialty | Immunology,dermatology,infectious diseases,endocrinology  |
HIV-associated lipodystrophy is a condition characterized by loss ofsubcutaneous fat associated with infection withHIV.[1]: 497
HIV-associated lipodystrophy commonly presents with fat loss in face, buttocks, arms and legs.[citation needed]
There is also fataccumulation in various body parts. Patients often present with "buffalo hump"-like fat deposits in their upper backs. Breast size of patients (both male and female) tends to increase. In addition, patients develop abdominal obesity.[citation needed]
The exact mechanism of HIV-associatedlipodystrophy is not fully elucidated. There is evidence indicating both that it can be caused byanti-retroviral medications and that it can be caused by HIV infection in the absence of anti-retroviral medication.[citation needed]
The development of lipoatrophy in people living with HIV has been historically linked to specific classes of early antiretroviral therapy (ART). Initial treatment regimens typically combined aprotease inhibitor (PI) with twonucleoside reverse transcriptase inhibitors (NRTIs), specificallythymidine analogs likestavudine (d4T) andzidovudine (AZT). While these drugs helped maintain CD4 T-cell levels, they were strongly associated with changes inlipid metabolism and significant subcutaneous fat loss, often resulting in a 30% reduction of fat in the extremities and noticeable facial wasting. Other older drugs, such as the non-nucleoside reverse transcriptase inhibitor (NNRTI)efavirenz, have also been implicated in fat loss.[2]
The incidence of the condition dropped dramatically following the transition to newer, less toxic medications. By the late 2000s, clinical guidelines recommended replacing zidovudine withtenofovir disoproxil fumarate (TDF), which exhibited significantly lower lipoatrophic effects. This was further improved by the introduction oftenofovir alafenamide (TAF), which is largely devoid of lipodystrophy.[2]
On the other hand, there is evidence thatHIV-1 infection on its own contributes to the development of the lipodystrophicphenotype by interfering with some key genes ofadipocytedifferentiation andmitochondrial function on patients which have not received antiretroviral treatment.[3]
Injectable fillers, including thecalcium hydroxylapatite-basedRadiesse andpoly-L-lactic acid-basedSculptra, are indicated to restore volume lost due to HIV-associated facial lipoatrophy.[4][5]
GHRH analogs such astesamorelin can be used to treat HIV-associated lipodystrophy.[citation needed]
Reversion of lipodystrophy does not occur after withdrawal of protease inhibitors.[2]
