HIV ASSOCIATED LIPODYSTROPHY: A MULTIDISCIPLINARY THERAPEUTIC APPROACH

The diagnosis of HIV-related lipodystrophy makes use of subjective and objective tools and instruments. The subjective methods may include self-administered questionnaires which reflect the change in the distribution of body fat or trivial increases the size of the collar of the shirt, bra or pants. Another simple procedure considers, however, the objective detection (by the doctor or patient) of anthropometric measures (chest, neck, abdominal girths, etc.). The diagnostic instruments that, for example, allow the measurement using CT scans of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), or alternatively the detection adipose tissue using the DEXA method (the acronym Double Energy X-ray Absorption)are more complex. DEXA "total body" examination in particular, allows not only an accurate assessment of body composition, including a survey of bone mineral density, but also a constant follow-up of HIV associated and drug-related osteoporosis.
But can lipodystrophy be treated?
Some aspects of the lipodystrophy syndrome can be covered, provided that we take a fundamental multi-specialists approach to the problem, involving a dietician (which emphasizes the dictates of an adequate and controlled food intake), a physiatrist (which shows the principles of a dedicated motor activity), a plastic surgeon (which tries to remedy the harm done), and an infectious disease specialist that coordinates and oversees the work of the other specialists.
Remembering this, we can then treat the associated metabolic abnormalities (dyslipidemia, hyperglycemia etc.) with a targeted pharmacological approach (fibrates, statins, oral antidiabetic drugs, etc.). In some patients, however, may be necessary to modify, or suspend, the pharmacology anti-HIV therapy (basically suspending protease inhibitors when there is lipohypertrophy, and reverse transcriptase inhibitors when there is lipoatrophy). In other cases, however, plastic surgery takes a predominant role by means of liposuction (in lipohypertrophy) or liporiconstruction (in lipoatrophy). Other surgical techniques utilize "fillers" for facial lipoatrophy (poly-lactic acid and polyacrylamide gel are used via intradermal injections that increase fibroblasts and collagen fibers, making the cheeks look less sunken). The echo-guided liposuction, however, seems to be the most suitable technique to reduce the "buffalo hump", an embarrassing change in appearance that consists in the accumulation of fat at the base of the neck. At the conclusion of this brief talk, is to be noted that, although the use of anti-HIV drug therapies have resulted in a significant decrease in AIDS-related mortality and an overall improvement in "management" of the disease, there are long-term side-effects ( iatrogenic) among which, lipodystrophy is one of the most important and certainly the most "visual"!