Lipodystrophy Syndrome: Diagnostic, Clinic and Therapeutic Aspects

Lipodystrophy (LD) in HIV-infected patients receiving HAART is a novel, polymorfic clinical entity that needs to be clearly defined. Its prevalence and diagnosis are not well established so far. It includes several disturbances, such as lipoatrophy and fat accumulation at different sites, and lipid and glucose metabolism alterations, including hyperlipidaemia, insulin resistance and lactic acidaemia. Several factors have been implicated, and no single etiological hypothesis has been able to account for the wide range of clinical manifestations. In fact, different entities could be underlying the process. However, little doubts remain as to the crucial role being played by protease inhibitors (PI) and nucleoside reverse transcriptase inhibitors (NRTI). Objective criteria to assess body-shape changes have not been defined. Morphological changes have psychological, social and treatment-adherence consequences, and there are very few therapeutic options currently available. Metabolic abnormalities may increase cardiovascular risk over the long term in some patients. A higher rate of coronary events and atherosclerotic disease in HIV+ patients under HAART are of great concern. For this reason, an adequate management of these disorders is decisive, to prevent cardiovascular morbidity and mortality in the future. Lactic acidaemia is a frequent complication associated with NRTI, but its clinical relevance is uncertain at the moment. Its most severe presentation is lactic acidosis, which requires a prompt diagnosis and treatment, given its fatal prognosis. Finally, less toxic antiretroviral strategies and/or a delay in its prescription might be warranted.