Lipodystrophy, Metabolic Disorders and Cardiovascular Risk - Complications of Antiretroviral Therapy

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Abstract

Introduction During the last decade, antiretroviral (ARV) combination therapy has dramatically reduced the mortality of HIV-infected individuals in the countries where these treatments are available. 1,2 Due to the substantially expanded life expectancy and the long-term use of antiretroviral therapy (ART), complications of these highly successful treatment strategies has gained much more attention. The two main complications today associated with antiretroviral therapy are the HIV-associated lipodystrophy and metabolic alterations affecting the lipid and glucose metabolism, which are often but not necessarily found to be associated (see Table 1).

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Table 1: Preliminary Classification of Symptoms of the HIV-associated Lipodystrophy Syndrome

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HIV-associated Lipodystrophy

Clinical Features and Diagnosis
For the affected patient, the most unpleasant adverse event of antiretroviral therapy is the change in body fat called HIVassociated lipodystrophy. The changes in adipose tissue, peripheral subcutaneous fat loss, visceral or dorsocervical fat accumulation or enlargement of the breast have a marked social and psychological impact and can be perceived as disfiguring and stigmatising (see Figures 1, 2a and 2b). Despite more than 10 years of previous experience with antiretroviral therapy, changes in body fat, as distinct from wasting, were only first reported in 1997. 3,4,5 Overall the prevalence has been reported as high as 80% in antiretroviral-experienced patients.


Figure 1: Facial lipoatrophy characterised by sunken cheeks and hollow temples due to buccal and subcutaneous fat loss

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