Lipodystrophy related to HIV-The Brazilian Public Health approach

Lipodystrophy associated with the human immunodeficiency virus (HIV) is an unpleasant disorder found in 6%-80% of patients infected with HIV. Brazil has a universal public health system, an effective program for patients diagnosed with HIV, providing lipodystrophy treatment since 2004. The objective of this article is to describe the Brazilian approach to this complication.

A search in the Brazilian Health Care Legislation and the Brazilian Health System database was conducted to identify all the inclusion criteria and surgical treatment offered to HIV patients with lipodystrophy, identify all the facilities that offer this, and describe their geographic distribution. In addition, the number of procedures performed was obtained.

The inclusion criteria were the following:¹ diagnosis of HIV/AIDS and lipodystrophy due to the use of antiretroviral drugs for at least 12 months;² no response or the impossibility of changing ART;³ clinical stability for six months without clinical manifestations suggestive of immunodeficiency in the last 6 months;⁴ laboratory results showing CD4 cell count >250 cells/mm³ and viral load <10,000 copies/ml in the last 6 months; and⁵ stable clinical and laboratory parameters. A total of 4,760 procedures were performed, with the most common procedure being facial filler with polymethylmethacrylate. Eleven hospitals were registered to offer this treatment.

The Brazilian Health Care System approach to lipodystrophy has an organized plan with universal and integral coverage. All the procedures offered were safe and well-tolerated, according to the literature. However, regional distribution is the main issue and needs to be improved.