Body-fat abnormalities in patients with HIV: progress and challenges

Area of Science:

• Infectious Diseases
• Endocrinology
• Pharmacology

Background:

• Antiretroviral therapy (ART) has evolved, reducing metabolic side effects like lipoatrophy seen with older drugs.
• HIV infection itself, independent of ART, can cause body composition changes.
• Lipoatrophy and fat redistribution were previously grouped as lipodystrophy but are now understood as distinct conditions.

Purpose of the Study:

• To differentiate lipoatrophy and dyslipidemia from central/peripheral lipohypertrophy and fat redistribution.
• To review the impact of HIV infection alone and newer ART on these body composition changes.
• To guide clinicians in selecting ART to minimize adverse body habitus changes without compromising viral suppression.

Main Methods:

• Review of current scientific literature.
• Analysis of recent clinical trial results.
• Pathophysiological distinction of lipoatrophy/dyslipidemia from lipohypertrophy/fat redistribution.

Main Results:

• Lipoatrophy and fat redistribution are distinct entities with different pathophysiological mechanisms.
• Both HIV infection and specific ART regimens contribute to body fat changes.
• Newer ART generally have a lower incidence of these metabolic complications compared to older regimens.

Conclusions:

• Understanding the distinct causes of lipoatrophy and fat redistribution is crucial for patient management.
• Physicians can utilize this knowledge to personalize ART selection, balancing efficacy and metabolic safety.
• Minimizing body habitus changes can improve patient adherence and quality of life during HIV treatment.