Approach Considerations

Human immunodeficiency virus (HIV)–associated lipodystrophy is a clinical diagnosis. Although there is not a specific clinical protocol to make the diagnosis, advancements have been made that can aid in the assessment of lipodystrophy. A 2014 cross-sectional European study showed that anthropometric ratios (fat-mass ratio, waist-to-thigh ratio, waist-to-calf ratio, and arm-to-trunk ratio) are useful in making the diagnosis of lipodystrophy. Incorporating this method can lead to an accurate and earlier diagnosis.^[62]

The only relevant laboratory studies are serum lipid assays. A skin or subcutaneous fat biopsy is not routinely performed to make a diagnosis of HIV lipodystrophy. 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.^[63]

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.^[64]

Lipid Panel

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 findings are as follows:

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 findings are as follows:

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

Treatment & Management

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

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Author

David T Robles, MD, PhD, FAAD Dermatologist, Oak Tree Dermatology

David T Robles, MD, PhD, FAAD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Jacquiline Habashy, DO, MSc Resident Physician, Department of Dermatology, Western University of Health Sciences College of Osteopathic Medicine of the Pacific

Jacquiline Habashy, DO, MSc is a member of the following medical societies: American Osteopathic College of Dermatology

Disclosure: Nothing to disclose.

Savannah Potter, BS Medical Scribe, Department of Dermatology, San Antonio Regional Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Roy M Colven, MD Associate Professor of Medicine (Dermatology), Adjunct Associate Professor of Global Health, University of Washington School of Medicine; Section Head of Dermatology, Harborview Medical Center

Roy M Colven, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Telemedicine Association, Phi Beta Kappa, and Washington State Medical Association