Lipodystrophy in HIV: Evolving Challenges and Unresolved Questions

Area of Science:

• Medical Science
• Virology
• Endocrinology

Background:

• Effective antiretroviral therapy (ART) for HIV emerged in the mid-1990s, preventing AIDS progression.
• ART was linked to HIV-associated lipodystrophy, characterized by fat redistribution and metabolic issues like insulin resistance.
• While newer ART regimens have reduced severe lipodystrophy, adipose tissue alterations persist.

Purpose of the Study:

• To review the evolving landscape of adipose tissue alterations in people living with HIV (PLWH) on modern antiretroviral therapy.
• To highlight the persistent risks of metabolic and cardiovascular complications associated with these changes.

Main Methods:

• Literature review of studies on HIV-associated lipodystrophy and antiretroviral therapy.
• Analysis of the impact of different ART generations on fat metabolism and distribution.
• Examination of current evidence on weight gain and specific fat depot hypertrophy in PLWH.

Main Results:

• Early ART (e.g., stavudine) caused significant lipoatrophy and lipomatosis, with associated metabolic disturbances.
• Modern ART, including integrase strand transfer inhibitors and tenofovir alafenamide, has decreased severe lipodystrophy.
• Current regimens are linked to weight gain resembling obesity and hypertrophy of visceral fat depots (epicardial, perivascular), increasing cardiovascular risk.

Conclusions:

• Despite advances in ART, PLWH remain vulnerable to adipose tissue alterations.
• These changes, including weight gain and visceral fat hypertrophy, pose ongoing metabolic and cardiovascular health risks.
• Optimized ART and vigilant monitoring of adipose tissue and metabolic status are crucial for improving PLWH health.