HIV/AIDS and lipodystrophy: Implications for clinical management in resource‐limited settings

Abstract

IntroductionLipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings.MethodsWe conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n=799), 90 studies were included in this review.Results and DiscussionOf the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden.ConclusionsLipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.

Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe

“…Table 1 shows the socio-demographic characteristics of the 1,242 HIV-positive adults who were enrolled in this study. There were 849 (68%) females and the overall median age of all participants was 41 years (IQR, [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Slightly more study participants resided in the rural areas (n = 699, 56%) compared to urban areas (n = 543, 44%).…”

Lipodystrophy HIV-related and FGF21: A new marker to follow the progression of lipodystrophy?

“…In particular, in this syndrome, there is a severe lipoatrophy [10] . Lipoatrophy is primarily subcutaneous fat loss.…”

Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS

“…Conclusões: A alta prevalência de lipodistrofia e alterações do metabolismo de lipídios e glicose evidenciam a importância da intervenção precoce nesse grupo de pacientes para prevenir complicações cardiovasculares. The diagnosis of lipodystrophy may be done through method such as clinal exams, self-report, electrical bio impedance (BIA) or techniques that provide quantitative data about adipose tissue such as dual energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI) and computed tomography (CT) 7 . The imaging methods have high operational cost, limited availability and, in the case of DEXA and CT, involve ionizing exposure, making it rather difficult to be used in clinical practice.…”