Clinical management of HIV-associated lipodystrophy

Lipodystrophy or fat re-distribution, and its associated metabolic abnormalities, are common in HIV patients. The pathogenesis is multifactorial. This article provides an update on the latest findings of the different clinical management strategies that have been utilized in patients with lipodystrophy.

Treatment strategies need to be different in those patients with lipoatrophy when compared with patients with central fat accumulation (lipohypertrophy). Most of the treatments studied have produced minimal or modest effects, which are not sustained when the therapy is discontinued. The treatment of associated metabolic abnormalities such as insulin resistance and hyperlipidemia should have similar goals to that in the non-HIV population, but is complicated by the fact that response may be worse and there is a need to consider drug-drug interactions with the antiretrovirals.

Multiple complex strategies will need to be utilized in these patients to treat the different features seen in lipodystrophy in order to reduce their long-term cardiovascular risk. Further research is also needed to evaluate combination therapies and to identify the underlying mechanisms in order to develop novel therapies for the future.