What are the other Names for this Condition? (Also known as/Synonyms)

• HIV Infection and Lipodystrophy
• Lipodystrophy and HIV Infection
• Lipodystrophy in HIV Infection

What is HIV-Associated Lipodystrophy? (Definition/Background Information)

• Lipomatosis is a benign condition of fatty tissue overgrowth, when abnormal levels of fat are spread over a wide area in the body with an uneven distribution pattern. The fatty tissues can even infiltrate the underlying or adjacent muscle layers
• HIV-Associated Lipodystrophy occurs against a background of HIV infection that is treated using antiretroviral therapy (ART). This condition is characterized by fat accumulation and/or fat-wasting with systemic involvement of the body
• Individuals with HIV infection show lipodystrophy (degeneration of fatty tissues in the body), generally when treated with protease inhibitors or other antiretroviral therapy medications. The condition is usually observed in older adults, though children and younger adults are also known to be affected
• The signs and symptoms of HIV-Associated Lipodystrophy may include swollen neck, abnormal belly fat deposition, and breast enlargement, due to excessive fat accumulation. The symptoms may also include emaciated facial profile and very thin legs and arms due to loss of fat
• The treatment for Lipodystrophy in HIV Infection includes the use of alternative medications for HIV infection and correction of symptoms associated with fat increase or decrease in the body through surgery. Suitable dietary modification and adequate/regular exercising is known to be beneficial in improving the condition
• The prognosis of HIV-Associated Lipodystrophy depends upon many factors including the duration of HIV and ART, health condition of the individual, and severity of the signs and symptoms among other factors

Who gets HIV-Associated Lipodystrophy? (Age and Sex Distribution)

• HIV-Associated Lipodystrophy occurs in individuals who have tested positive for HIV infection and are being treated with antiretroviral therapy (ART). It is important to note that not all individuals with HIV infection and treated with ART are affected
• HIV infection is typically more common in younger adults than other age groups due to their risky behaviors, such as multiple sex partners, usage of injectable drugs, etc. However, HIV-Associated Lipodystrophy is more often present in older adults
• Individuals belonging to a wide age range (including children) are known to be affected
• There is no gender preference and both males and females are affected
• Generally, there is no known geographical, racial, or ethnic preference; although, some studies indicate a higher prevalence among Caucasians (in comparison to dark-skinned individuals)

Note: Among HIV-infected individuals undergoing therapy with antiretroviral drugs the world over, the incidence of lipodystrophy is stated to range from 10% to 80%.

What are the Risk Factors for HIV-Associated Lipodystrophy? (Predisposing Factors)

The primary risk factor for HIV-Associated Lipodystrophy is antiretroviral therapy for HIV infection. The infection leads to poor immune system in the affected individual and they are often observed to be severely immunocompromised. Medications used in antiretroviral therapy are believed to contribute to the condition, and the following classes of drugs have been potentially identified:

• Medications that belong to nucleoside reverse transcriptase inhibitor (NRTI) category are associated with loss of fat from various parts of the body
• Medications that belong to the following categories are associated with fat accumulation at various body parts:
  • Protease inhibitor (PI)
  • Non-nucleoside reverse transcriptase inhibitor (NNRTI)
  • Integrase inhibitor (INSTI)

HIV-Associated Lipodystrophy is also reported to be influenced by the following secondary set of factors:

• Age, gender, and race of the individual: Elderly adults, women, and individuals of Caucasian racial profile are implicated
• Duration: An increased time period and severity of HIV infection and an increased duration of highly-active antiretroviral therapy (HAART) are associated with greater risks
• Constitution of the body prior to therapy, such as higher body fat, low BMI, high triglyceride levels, and lower CD4 lymphocyte cell count, are factors that lead to a higher risk for HIV-Associated Lipodystrophy
• Presence of AIDS or other comorbidities such as hepatitis infection

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of HIV-Associated Lipodystrophy? (Etiology)

The exact cause and mechanism of HIV-Associated Lipodystrophy formation is unknown.

• The condition is thought to occur as an adverse reaction to certain medications that are taken as part of the antiretroviral therapy regimen for HIV infection
• In many cases, a combination of medications are recommended by the healthcare provider during treatment; and, this can cause difficulties in establishing the offending drug(s)
• The patterns of abnormal fat distribution in the body depend on the class of drugs used in the therapy, and to a lesser extent on the gender (whether male or female), health status, and age of the individual
• Studies indicate that the longer the duration of ART (typically over 2 years) and the more severe is the infection, the greater is the possibility of lipodystrophy in HIV-affected individuals
• Not all individuals treated with HIV medications are observed to be affected. Some researchers believe that certain individuals are more at risk than others due to their genetic makeup, which makes them more vulnerable to lipodystrophy

What are the Signs and Symptoms of HIV-Associated Lipodystrophy?

HIV-Associated Lipodystrophy can affect multiple regions of the body. Lipodystrophy is a condition of fatty tissue degeneration or an excess accumulation of fat in the body, resulting in abnormal body fat distribution. The condition is known to gradually develop over a period of 1.5 to 2 years, following which it may stabilize for a certain period of time.

• The abnormal buildup of fat at certain locations in the body is termed lipohypertrophy (or lipoaccumulation). This is generally represented by the following conditions:
  • Excess fat between the shoulders behind and below the neck (buffalo hump)
  • Swelling of the neck; the expansion may be 5-10 cm all around
  • Enlarged breast(s)
  • Presence of abdominal and belly fat
  • Lipomas in the pubic region
• Fatty tissue degeneration or the loss of local fat from parts of the body is termed lipoatrophy. This is represented by:
  • Absence of fat in the face (especially from the cheeks which can make it appear very prominent)
  • Fat wasting from the limbs (both arms and legs)
  • Loss of fat and tissue in the thighs and buttocks

Most affected individuals display either lipohypertrophy or lipoatrophy; however, a small-to-moderate percentage of individuals display both features (mixed presentation). The fatty tissue deposition or depletion can take place at/from any body site (multiple locations), giving rise to the associated signs and symptoms.

As a consequence of the above, the following additional signs and symptoms of HIV-Associated Lipodystrophy may be noted:

• Headaches and neck pain
• Sleep apnea
• Breathing difficulties
• Increased blood lipid levels (hyperlipidemia)
• Insulin resistance resulting in sugar buildup in blood
• Increased blood lactate levels
• Osteopenia (mostly affecting the lumbar spinal region) and osteoporosis due to decreased bone density

How is HIV-Associated Lipodystrophy Diagnosed?

Currently, there is no specific diagnostic protocol established for HIV-Associated Lipodystrophy. A diagnosis may be made using the following tests and exams:

• Complete physical examination (including anthropometric evaluation) with thorough evaluation of the individual’s medical history
• Blood tests or lipid panel: Individuals with the condition may have increased blood lipid and/or sugar levels
• X-ray absorptiometry to study bone density
• CT and MRI scan of the affected region: It can show the extent of fat accumulation in various parts of the body
• Tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A biopsy of the fatty tumors is generally not undertaken towards establishing a diagnosis of lipodystrophy in HIV-infected individuals.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of HIV-Associated Lipodystrophy?

The complications from HIV-Associated Lipodystrophy could include:

• Severe emotional stress from cosmetic issues; physical disfigurement
• Severely affected quality of life, poor self-esteem
• Sexual dysfunction
• Increased risk for diabetes
• Increased risk for atherosclerosis, and thus, for heart attack
• Formation of multiple, subcutaneous, painful nodules called angiolipomas
• Damage to organs during surgery to remove the fatty accumulations
• Recurrence of the condition following surgery may be observed
• Complications due to underlying HIV infection

How is HIV-Associated Lipodystrophy Treated?

Currently, there is no cure for HIV-Associated Lipodystrophy. The treatment measures are undertaken to stop progression of the condition and improve the symptoms. It may include the following:

• Withdrawal of antiretroviral drugs causing lipodystrophy in a controlled and phased manner, as determined by the healthcare provider. This is followed by the administration of alternative medications to treat the underlying HIV infection
• Recombinant growth hormone therapy has been used with a measure of success
• Use of medications to reduce accumulation of excess fat in the body
• Management of metabolic conditions causing increased blood lipid (cholesterol) and sugar levels
• Surgical excision with removal of the entire tumor can be attempted. However, since there is a risk of recurrence, the surgery is undertaken to offer relief from symptoms and improve the quality of life
• Liposuction to remove excess fat accumulation from the body, mainly for buffalo hump reduction
• Cosmetic or plastic surgery to improve or restore facial profile; use of fat-filler injections
• Suitable lifestyle and dietary modifications (including adequate physical activities and exercising to build muscles) depending upon blood levels of sugar, lipids, or cholesterol
• Follow-up care with long-term regular screening and check-ups are important and encouraged

How can HIV-Associated Lipodystrophy be Prevented?

Current medical research has not established a way of preventing HIV-Associated Lipodystrophy. However, some of the risk factors for the condition may be addressed:

• Undertaking appropriate and early treatment for HIV-infection
• Thorough evaluation by the healthcare provider to determine the best combination of antiretroviral medications to be administered
• Appropriate food and lifestyle changes to improve body metabolism performance and reduce risk for heart and vascular conditions; a diet rich in fiber and protein and low in fat is generally recommended (in some cases)
• Physical exercising and activities have been found to be beneficial in individuals with the condition

What is the Prognosis of HIV-Associated Lipodystrophy? (Outcomes/Resolutions)

• The prognosis of HIV-Associated Lipodystrophy depends upon several factors including:
  • Duration and severity of HIV infection (signs and symptoms)
  • Duration of antiretroviral therapy (ART)
  • Age of the individual
  • Overall health of the individual
  • Response to treatment
• The condition is known to progress and get worse over time. But, with effective and early treatment through the use of alternative medications for ART, HIV-Associated Lipodystrophy may be managed suitably
• Complications due to increased blood sugar or blood cholesterol levels may increase the risk for cardiovascular conditions and significantly affect the overall prognosis
• It is observed that newer medications used in ART therapy are lesser prone to causing lipodystrophy in HIV-infected patients

Additional and Relevant Useful Information for HIV-Associated Lipodystrophy:

• HIV infection is caused by the human immunodeficiency virus (HIV), a virus which gradually destroys the immune system
• The period of infectivity that immediately follows an infection with HIV, can be termed as acute HIV infection. It is the second stage in HIV infection that occurs after the incubation period, but before latency and potential AIDS stage

The following links can help you understand HIV infection and AIDS:

http://www.dovemed.com/diseases-conditions/acute-human-immunodeficiency-virus-hiv-infection/

http://www.dovemed.com/diseases-conditions/acquired-immunodeficiency-syndrome-aids/