Lipodystrophy in HIV Clinical Presentation

Updated: Aug 13, 2021
  • Author: David T Robles, MD, PhD, FAAD; Chief Editor: Dirk M Elston, MD  more...
  • Print
Presentation

Physical Examination

Human immunodeficiency virus (HIV)–associated lipodystrophy is a progressive disease; its severity is directly proportional to age, duration of disease, and length of protease inhibitor (PI) and/or nucleoside reverse transcriptase inhibitor (NRTI) treatment.

Abnormal fat accumulation (lipohypertrophy) findings

The dorsocervical fat pad (commonly called "buffalo hump") becomes variably enlarged. [55, 56, 57]

The circumference of the neck expands by 5-10 cm.

Breast hypertrophy occurs.

Central truncal adiposity results from abdominal visceral fat accumulation ("Crix belly" [referring to Crixivan, the trade name for indinavir, a PI] or "protease paunch").

Symmetric and asymmetric lipomatoses may occur; a rare pattern of lipoaccumulation involving bandlike lipomatosis tissue symmetrically from the breasts, laterally to the axillae, has been reported. [58]

Suprapubic fat pads (pubic lipomas) occur in nearly 10% of patients with lipodystrophy. [59]

The development of multiple angiolipomas is associated with PI therapy. [60]

Lipoatrophy findings

Temporal wasting and loss of subcutaneous fat from the cheeks (buccal fat pad) produces an emaciated appearance with prominent nasolabial creases (see image below).

Subcutaneous tissue is depleted from the arms, shoulders, thighs, and buttocks (peripheral wasting), with prominence of the superficial veins in these sites.

Facial HIV-associated lipodystrophy in a patient r Facial HIV-associated lipodystrophy in a patient receiving highly active antiretroviral therapy.