Disorders of Body Fat Distribution in HIV-1-Infected Patients

Body fat disorders are a common and relevant problem in HIV-1-infected patients that can be associatedwith metabolic alterations. Many controversies in their definition, pathogenesis, measurement, andmanagement remain unclear. Several factors including HIV-1 infection itself and antiretroviral therapyhave been associated with the development of these alterations. Most studies show that the action ofdrugs on the pathogenesis of lipoatrophy is undeniable. However, they also show that there are considerabledifferences not only between the different families of antiretroviral drugs, but also between the individualmembers of these families. The diagnosis of lipodystrophy is limited by the absence of an agreed definitionand a reference for normality. Accurate diagnosis, especially in mild-moderate cases, is difficult, almostalways subjective, not standardized, and cannot be carried out by a single method. In general, subjectiveevaluation by the physician and patient, together with simple techniques such as anthropometry, canprovide highly valuable information, especially when used over time. Although there is no knowntherapy to completely reverse lipodystrophy once it becomes established, there is evidence that lipoatrophycan be partially improved by replacing thymidine analogs in certain cases. In addition, reparativesurgery may prove useful in moderate or severe cases. Neither the interruption of antiretroviral therapynor the use of metformin, glitazones or growth hormone analogs can be recommended due to theirlimited efficacy or associated complications.