Human Immunodeficiency Virus Book

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LipodystrophyAka: Lipoatrophy, Peripheral Fat Wasting, Crix Belly, Protease Paunch, Buffalo Humps, Second Chins, Atrophic Facial Cheeks

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  1. Pathophysiology
    1. Occurs in some patients never exposed to Antiretroviral
    2. Common adverse effect of anti-Retroviral therapy
      1. Occurs in 64% of patients on Protease Inhibitors
  2. Signs
    1. Peripheral fat wasting
      1. Loss of facial fat (e.g. cheeks with deep dimples)
      2. Loss of subcutaneous fat in the legs
    2. Redistribution of fat centrally
      1. Increased abdominal fat (protease paunch)
      2. Gynecomastia
      3. Neck fat pad hypertrophy (Buffalo hump)
        1. Seen also in Cushing's Syndrome
    3. Hyperlipidemia
    4. Insulin Resistance
  3. Complications
    1. Pancreatitis
    2. Pro-thrombotic state with potential increased risks
      1. Cerebrovascular Accident (stroke)
      2. Increased risk of cardiovascular disease
      3. Mortality may be increased
  4. Management
    1. Low Fat Diet
    2. HMG CoA Reductase Inhibitors (Statins)
    3. Fibric Acid derivatives (Gemfibrozil)
    4. Liposuction with redistribution to areas of fat loss
    5. Consider adjusting Antiretroviral regimen
      1. Change Protease Inhibitor (Indinavir to Nelfinavir)
      2. Switch Protease Inhibitor to another Antiretroviral
        1. Nevirapine (Viramune)
        2. Efavirenz (Sustiva)
    6. Hyperinsulinemia
      1. Metformin
      2. Thiazolidinediones (e.g. Rosiglitazone)
        1. Efficacy and safety in Lipodystrophy is unclear
  5. References
    1. Lieu (2001) CMEA Medicine Lecture, San Diego
    2. Hadigan (2001) {a 10211} Clin Care 13:13
    3. Hadigan (2000) JAMA 284:472
    4. Kuwahara (2002) Am Fam Physician 65(7):1405

Lipodystrophy (C0023787)

Definition (MSH)A collection of heterogenous conditions resulting from defective LIPID METABOLISM and characterized by ADIPOSE TISSUE atrophy. Often there is redistribution of body fat resulting in peripheral fat wasting and central adiposity. They include generalized, localized, congenital, and acquired lipodystrophy.
Definition (CSP)collection of rare conditions resulting from defective fat metabolism and characterized by atrophy of the subcutaneous fat; includes total, congenital or acquired, partial, abdominal infantile, and localized lipodystrophy.
ConceptsDisease or Syndrome (T047)
ICD9272.6
MSHD008060
EnglishCUTANEOUS LIPODYSTROPHY, Dystrophy of fatty tissue, Lipodystrophies, Lipodystrophy
Spanishdistrofia del tejido graso, lipodistrofia
Parent ConceptsLipid Metabolism Disorders (C0154251), Lipids abnormal (C0549634), Skin Diseases, Metabolic (C0037279), Lipodystrophy (C0023787), Lipoatrophy and lipodystrophy (C0406604)
SourcesAOD, COSTAR, CSP, CST, ICD9CM, MSH, MTH, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Lipoatrophy (C1280433)

ConceptsDisease or Syndrome (T047)
EnglishLipoatrophy
Spanishlipoatrofia
Parent ConceptsLipoatrophy and lipodystrophy (C0406604)
SourcesCSP, DXP, MTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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