Fat Redistribution Syndromes Associated with HIV-1 Infection and Combination Antiretroviral Therapy

More than 15 years after the introduction of highly active antiretroviral therapy, HIV/HAART-associatedlipodystrophy syndrome still shadows the indisputable efficacy of antiretroviral therapy. Several issuesrelated to this complication (prevalence, diagnosis, pathogenesis, prevention, or clinical management)have not been completely clarified. However, in the last years, substantial progress has been made inelucidating some of these basic aspects. This includes a better knowledge of the pathogenic mechanismsunderlying HIV/HAART-associated lipodystrophy syndrome such as genetic host determinants, theimpact of HIV infection per se, as well as the contribution of antiretroviral therapy. In regard to treatment,we have learned that certain drugs are especially prone to cause HIV/HAART-associated lipodystrophysyndrome (i.e. thymidine analogues). Pharmacological interventions to treat this condition have yieldedmostly disappointing results, and the only intervention which offers an immediate aesthetical improvementfor patients with HIV/HAART-associated lipodystrophy syndrome is plastic surgery. Even under themost favorable conditions (ideal host genetic make-up, and the timely initiation of HIV therapywith less toxic drugs), current data show that HIV/HAART-associated lipodystrophy syndrome is acomplication of HIV infection and/or antiretroviral treatment that we are unable to avoid. In the contextof HIV-1-infected patients under long-term antiretroviral therapy, fat toxicity is still the dark side of therainbow.