Abstract
Lipodystrophy syndromes are rare heterogenous disorders that are classified based on fat distribution, age of onset, and etiology. The pathophysiology in this group of conditions is secondary to the loss of mature functional adipocytes due to signaling errors. Diagnosis is made clinically and should be suspected in the setting of observed adipose distribution, insulin resistance, low leptin, or hypertriglyceridemia.
HIV-associated lipodystrophy (HALS) is one of the complications of HAART and is reported among 12–33% of patients with HIV in developed countries, with a higher prevalence seen in middle- and low-income countries.
Potential treatments for HALS include tesamorelin, a GHRH analog; r-metHuLeptin (metreleptin), a recombinant human leptin analog; or thiazolidinediones via activation of peroxisome proliferator-activated receptor-γ (PPAR-γ) that is downregulated by HAART therapy. Randomized trials demonstrate benefits in each of these drug classes, though there are no head-to-head comparison trials.
Early diagnosis of HALS is essential for prevention of its metabolic implications. Clinicians must consider the risks, benefits, and costs when deciding among the potential therapies available.
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References
Brown RJ, et al. The diagnosis and management of lipodystrophy syndromes: a multi-society practice guideline. J Clin Endocrinol Metabol. 2016;101(12):4500–11.
Tsoukas MA, Farr OM, Mantzoros CS. Leptin in congenital and HIV-associated lipodystrophy. Metabolism. 2015;64(1):47–59.
Finkelstein JL, et al. HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings. J Int AIDS Soc. 2015;18(1):19033.
Spooner LM, Olin JL. Tesamorelin: a growth hormone-releasing factor analogue for HIV-associated lipodystrophy. Ann Pharmacother. 2012;46(2):240–7.
Benedini S, et al. Recombinant human growth hormone. BioDrugs. 2008;22(2):101–12.
Lee JH, et al. Recombinant methionyl human leptin therapy in replacement doses improves insulin resistance and metabolic profile in patients with lipoatrophy and metabolic syndrome induced by the highly active antiretroviral therapy. J Clin Endocrinol Metabol. 2006;91(7):2605–11.
Edgeworth A, Treacy MP, Hurst TP. Thiazolidinediones in the treatment of HIV/HAART-associated lipodystrophy syndrome. AIDS Rev. 2013;15(3):171–80.
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Al Shamy, T., Via, M.A. (2022). HIV Infection and Lipodystrophy. In: Davies, T.F. (eds) A Case-Based Guide to Clinical Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-030-84367-0_61
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DOI: https://doi.org/10.1007/978-3-030-84367-0_61
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