Reviewer: Li Xin (Beijing Ditan Hospital Affiliated to Capital Medical University)
Lipodystrophy refers to problems with the way the body synthesizes, uses and stores fat, also known as abnormal fat distribution.
This disorder is common with older antiretroviral (ART) therapy, newer ART use, better control of HIV infection, and increased risk of lipodystrophy reduced.
One. Symptoms
There are two types of lipodystrophy: fat loss and fat accumulation.
Fat loss, commonly known as lipoatrophy, is common in men and occurs in the following areas:
In the upper and lower limbs, the veins in these parts will be more obvious than normal;
Facial, which can result in sunken cheeks, temples, or eye sockets;
Buttocks.
Women are more likely to have fat deposits. Fat accumulation is also known as fat hyperplasia and obesity. Fat accumulation is commonly found in:
abdomen and lower abdomen;
Breasts (may also appear in men);
The back of the neck and shoulders, sometimes called the “buffalo back”.
A person can develop a fatty mass in other parts of the body, called a lipoma.
Image source: Zhanku Hailuo
Second, the cause
Older drugs for HIV infection such as stavudine, zidovudine, and some other older protease inhibitors, such as indinavir, have been associated with lipodystrophy.
And the longer it is used, the higher the risk. Newer drugs for HIV infection, as well as newer protease inhibitors such as darunavir, are less likely to cause lipodystrophy.
HIV itself also interferes with the body’s fat metabolism. The more severe the HIV infection and the longer the infection, the higher the likelihood that the patient will develop lipodystrophy.
The following are more likely to develop lipodystrophy:
Senior;
Caucasian;
Obesity, or a significant change in weight.
It is important to note that fat loss can also be caused by AIDS wasting syndrome.
Three, diagnosis
Physical examination is diagnostic. Doctors measure the patient’s arm, thigh, waist, hip, and neck circumferences as baselines and record them for comparison with future measurements.
Lipodystrophy is often accompanied by other metabolic problems, such as hypercholesterolemia and insulin resistance. Insulin resistance can lead to diabetes. And these diseases can lead to other problems, such as an increased risk of heart disease.
That’s why doctors usually check a patient’s blood pressure and ask the patient to do a blood test to find out:
Cholesterol levels, including LDL (bad cholesterol) and HDL (good cholesterol);
Triglyceride (a type of blood lipid) level;
Glucose levels.
Image source: Zhanku Hailuo
Four. Treatment
It is important not to stop taking medicines for HIV infection. Although the cause of lipodystrophy may not be due to these drugs, doctors usually still change the drug combination.
New anti-HIV drugs, such as integrase chain transfer reaction inhibitors, are less likely to cause lipodystrophy.
Exercise and healthy food choices can help build muscle and reduce fat accumulation. Exercise also improves the body’s ability to use insulin. Whether it’s aerobic or strength training (weight-bearing exercise), it builds strength and supports heart health.
And both reduce belly fat. However, be careful not to lose weight too quickly.
Occasionally patients may need to take medicines designed to treat lipodystrophy or related conditions, such as:
Temorelin, a daily injection that reduces belly fat, can causeThe possibility of elevated blood sugar.
Metformin, used to treat high blood sugar and insulin resistance.
Atorvastatin or rosuvastatin, used to treat high cholesterol.
Other treatments include:
Hormonal therapy, such as testosterone and human growth hormone.
Orthopedic implants.
Injectables that increase skin thickness and fill collapsed cheeks.
Surgery to remove accumulated fat.
Image source: Zhanku Hailuo
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