eMedicine Specialties > Dermatology > Diseases of the Subcutaneous Tissue

Lipodystrophy, HIV: Differential Diagnoses & Workup

Author: David T Robles, MD, PhD, Dermatologist, Kaiser Permanente Southern California
Coauthor(s): Jonathan M Olson, BS, University of Washington School of Medicine; Roy M Colven, MD, Associate Professor of Medicine (Dermatology), University of Washington School of Medicine; Section Head of Dermatology, Harborview Medical Center; Attending Physician, Department of Dermatology, Harborview Medical Center, Madison and Medical Specialties Clinics
Contributor Information and Disclosures

Updated: Dec 8, 2008

Differential Diagnoses

Lipodystrophy, Acquired Partial
Lipodystrophy, Generalized
Lipodystrophy, Localized
Lipodystrophy, Progressive

Other Problems to Be Considered

Seip-Berardinelli syndrome
Lawrence syndrome
Dunnigan syndrome
Kobberling syndrome
Barraquer-Simons syndrome
Abdominal carcinoma
Malnutrition

Lipohypertrophy

Cushing disease
Glucocorticoid therapy
Scleredema of diabetes mellitus
Launois-Bensaude syndrome

Lipoatrophy

HIV wasting syndrome
Localized lipodystrophy
Malnutrition
Anorexia nervosa
Hyperthyroidism
Cancer cachexia
Severe chronic infection
Adrenal insufficiency

Workup

Laboratory Studies

Because abnormal glucose and/or lipid metabolism may accompany HIV lipodystrophy, checking the lipid panel and assessing for glucose intolerance is important prior to initiating antiretroviral therapy. Some experts suggest checking these values again at 6 months and then, if the results are normal, yearly.

  • Hyperlipidemia
    • Fasting cholesterol level – Greater than 200 mg/dL
    • Fasting triglyceride level - Greater than 150 mg/dL
    • Increased apolipoprotein c-III and apolipoprotein E levels
  • Hyperglycemia and/or hyperinsulinemia
    • Diabetes - Fasting plasma glucose level of greater than 126 mg/dL or a 2-hour oral glucose tolerance test result of greater than 200 mg/dL
    • Impaired fasting glucose - Fasting plasma glucose level of 100-125 mg/dL
    • Impaired glucose tolerance: Two-hour oral glucose tolerance test result of 140-199 mg/dL

Imaging Studies

Imaging studies are not generally necessary in the workup of HIV lipodystrophy. Dual energy x-ray absorptiometry scanning, CT scanning, and MRI are limited to research studies to objectively quantify fat abnormalities.

  • MRI demonstrates the accumulation of visceral fat in the abdomen compared with subcutaneous fat.
  • CT scanning demonstrates abnormal fat proliferation throughout the abdomen in a perivisceral distribution and little subcutaneous fat. Intra-abdominal organs are normal, and no ascites is seen.
  • Dual-energy x-ray absorptiometry may demonstrate lumbar spine bone density reduction in association with increased visceral fat accumulation.

Histologic Findings

A skin or subcutaneous fat biopsy is not routinely performed to make a diagnosis of HIV lipodystrophy.

More on Lipodystrophy, HIV

Overview: Lipodystrophy, HIV
Differential Diagnoses & Workup: Lipodystrophy, HIV
Treatment & Medication: Lipodystrophy, HIV
Follow-up: Lipodystrophy, HIV
Multimedia: Lipodystrophy, HIV
References
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References

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Further Reading

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Keywords

lipohypertrophy, lipoatrophy, lipodystrophy, human immunodeficiency virus, HIV, antiretroviral medication, protease inhibitor, highly active antiretroviral therapy, HAART

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Contributor Information and Disclosures

Author

David T Robles, MD, PhD, Dermatologist, Kaiser Permanente Southern California
David T Robles, MD, PhD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Jonathan M Olson, BS, University of Washington School of Medicine
Disclosure: Nothing to disclose.

Roy M Colven, MD, Associate Professor of Medicine (Dermatology), University of Washington School of Medicine; Section Head of Dermatology, Harborview Medical Center; Attending Physician, Department of Dermatology, Harborview Medical Center, Madison and Medical Specialties Clinics
Roy M Colven, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Telemedicine Association, Phi Beta Kappa, and Washington State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ronald A Greenfield, MD, Professor, Department of Internal Medicine, Section of Infectious Diseases, University of Oklahoma College of Medicine
Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Wyeth Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist  Speaking and teaching

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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