HIV-associated lipodystrophy: a review from a Brazilian perspective

Abstract

The prognosis of human immunodeficiency virus (HIV)-infected individuals has dramatically improved worldwide since the introduction of highly antiretroviral therapy. Nevertheless, along with the decrease in mortality, several body modifications not initially related to HIV infection have been reported. Disorders in lipid and glucose metabolism, accompanied by body shape abnormalities and alterations in fat distribution, began to be described. A syndrome, named “HIV-associated lipodystrophy syndrome”, was coined to classify these clinical spectrum aspects. This syndrome involves not only metabolic alterations but also fat redistribution, with lipoatrophy due to subcutaneous fat loss (predominantly in the face and lower limbs) and lipohypertrophy related to central fat gain. These changes in body shape are very important to be recognized, as they are associated with worse morbidity and mortality. Self-esteem difficulties related to body alterations might lead to treatment failures due to medication adherence problems. Moreover, these alterations have been associated with an increased risk of cardiovascular events. Therefore, it is extremely important to identify this syndrome early in order to provide an even better quality of life for this population, as the clinical approach is not easy. Treatment change, medications to treat dyslipidemia, and surgical intervention are instruments to be used to try to correct these abnormalities. The aim of this study is to review clinical presentation, diagnosis, and management of body shape and metabolic complications of HIV infection from a Brazilian perspective, a medium income country with a large number of patients on antiretroviral therapy.

Association between lipodystrophy and length of exposure to ARTs in adult HIV-1 infected patients in Montreal

“…Combination antiretroviral medications (ARTs) improved the survival and quality of life of HIV infected patients, but they have many side effects. Lipodystrophy and metabolic abnormalities, among other adverse reactions may lead to cardiovascular problems [1–5].…”

“…LD causes body changes which are usually associated with a decrease in self-esteem and leads to decreasing of adherence to ART and is associated to cardiovascular problems [1] This syndrome can also impact on quality of life, causes mental health disorders [10] and ultimately lead to treatment failure [1, 10]. Dual energy X-ray absorptiometry (DEXA) scan is a reliable method for definition of this syndrome [9].…”

Human Immunodeficiency Virus and Risk of Type 2 Diabetes in a Large Adult Cohort in Jos, Nigeria

“…HIV causes insulin resistance and dyslipidemia [ 11 ], and HCV is associated with intrahepatic elevation of tumor necrosis factor–α levels, insulin resistance, and liver disease [ 12 ]. Although initial studies associated the onset of diabetes in PLWHA to ART containing protease inhibitors (PIs) [ 13 , 14 ], which cause hyperglycemia by preventing the uptake and metabolism of glucose and lipids by adipocytes and hepatocytes [ 15 ], findings subsequently pointed toward the nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors by virtues of their mitochondrial toxicity and apoptosis of adipocytes [ 9 , 16 ]. However, recent studies have suggested that traditional risk factors for diabetes such as age and body weight are the major predictors of the development of type 2 diabetes mellitus (T2DM), as opposed to medications [ 6 ].…”

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“…The development of combined antiretroviral therapy (ARVT), which rendered the important sustained suppression of viral replication, modified the clinical course of AIDS and its epidemic profile (1). The free and universal access to ARVT, established by the Brazilian government, caused a profound impact in the history of HIV infection, decreasing mortality and opportunistic infections, and had a consequent increase in the survival of carriers (2). According to the data from the Boletim Epidemiológico de 2014 (3), until October of that year, around 400 thousand people who live with HIV/AIDS (PVHA = PLWHA) had received ARVT for free from the Unified Health System (SUS) (4).…”