Lipodystrophy Syndrome in Patients with HIV Infection

Abstract

Current antiretroviral therapy has lead to longer survival in patients infected with HIV, but it is also associated with new and important problems. Body fat redistribution and metabolic abnormalities, the so-called lipodystrophy syndrome, are among the most prevalent and worrisome ones. While an increasing number of patients infected with HIV are becoming affected by this syndrome, the pathogenesis of this syndrome and how to prevent and treat the problem all remain largely unknown. Body fat changes stigmatise the bodies of patients infected with HIV giving them a similar look to that seen in patients some years ago when the wasting syndrome was more prevalent and HIV infection was ultimately fatal. The psychological impact of body fat changes may be severe enough to affect a patients' desire to continue with antiretroviral therapy. Metabolic abnormalities, probably with the exception of symptomatic diabetes mellitus and hypertriglyceridaemia-induced pancreatitis, do not have an immediate impact on the quality of the lives of patients with HIV. However, their potential long term cardiovascular and bone consequences may increase the morbidity and the mortality of patients infected with HIV through noninfectious diseases. The impact of lipodystrophy on patients infected with HIV is not readily captured with the classic instruments used to measure quality of life and hence it is necessary to modify them urgently. Though treating lipodystrophy seems fully justified, there is no proven treatment for this problem, although a number of treatments have been used with varying success. Despite the recognition that lipodystrophy may have important psychological repercussions, the best psychological approach for this problem is not known at present. Although lipodystrophy has its own peculiarities, existing knowledge about how to psychologically help other patients with deforming body changes might be of help for patients infected with HIV, or at least may act as a starting point.

A randomized open‐label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection

“…Median visual analogue scores for the face did not differ at baseline, being 2 [interquartile range (IQR) 1-3] for the immediate-treatment group and 1 (IQR 0-2) for the delayed-treatment group (P 5 0.072) but were significantly different at week 12 [7][8] for the immediatetreatment group and 1 (IQR 1-4) for the delayed-treatment group (Po0.001)]. These differences had resolved by week 24 [6][7][8] for the immediate-treatment group and 7 (IQR 4-8) for the delayed-treatment group (P 5 0.97)].…”

“…Facial lipoatrophy is the most obvious and stigmatizing manifestation of HIV-related lipoatrophy [6]. In other acquired lipoatrophies, plastic surgery remains the mainstay of treatment.…”

Desafios da adesão ao tratamento de pessoas vivendo com HIV/Aids no Brasil

“…It is possible that the challenges to adhere may have changed. Effects from prolonged use of medication, such as lipodystrophy, 8,12 are known at present.…”

La santé mentale des femmes séropositives en France à l'ère des thérapies antirétrovirales : quelles différences avec les hommes ? Quels enjeux ?

“…Par ailleurs, par leurs effets indirects, et au-delà de la problé-matique de la qualité de vie, ces changements touchant l'image corporelle peuvent avoir un impact sur la volonté des femmes de poursuivre leur traitement, comme cela a pu être mis en évi-dence précédemment [50], sur l'observance au traitement [27], mais aussi sur les tentatives de suicide comme le mettent en évidence les données issues de l'enquête Vespa. Ce résultat souligne, une fois encore, la nécessité de développer une prise en charge psychologique adaptée qui tienne compte des effets secondaires des thérapies antirétrovirales.…”