HIV lipodystrophy: review of the syndrome and report of a case treated with liposuction

Open neck lipectomy for patients with HIV-related cervical lipohypertrophy

BACKGROUND

The advent of effective antiviral medications has revolutionised the management of the HIV-infected patients. Although this has helped in achieving prolonged symptom control, high numbers of these patients are left with the stigmata of complications associated with the medication. Lipodystrophy, either as lipoatrophy or lipohypertrophy, is a known complication of long-term HIV infection and aggressive antiviral therapy, leading to significant physical and psychological morbidity in these patients.

METHODS

Eleven patients demonstrating HIV-related anterolateral neck lipohypertrophy were offered the option of an open cervicoplasty involving pre- and subplatysma lipectomy, platysmaplasty, liposuction, and face-lift in selected patients.

RESULTS

The amount of adipose tissue excised from each patient was higher than that normally achieved through liposuction, with the highest total of 140 g in one patient. The degree of cervical contouring was significant, with all patients reporting profound satisfaction in terms of restoration of a cosmetically acceptable neck contour. Complications included two hematomas and one seroma. There was no incidence of infection.

CONCLUSION

Open anterior cervicoplasty with subplatysma contouring is a powerful tool for predictable and safe results and should be considered as one of the valuable treatment options for HIV-related anterolateral neck lipohypertrophy. Although the incidence of complications is higher than that for similar non-HIV patients, the degree of improvement it provided was perceived by patients as very rewarding.

New and emerging agents in the management of lipodystrophy in HIV-infected patients

Lipodystrophy remains a major long-term complication in human immunodeficiency virus-infected patients under antiretroviral (ARV) therapy. Patients may present with lipoatrophy or lipohypertrophy or both. The choice of treatments to improve fat redistribution depends on the form of lipodystrophy and its duration. Measures known to improve lipoatrophy are switches in ARV therapy (stavudine or zidovudine to abacavir or tenofovir) and filling interventions. Pioglitazone may be added to these measures, although any benefits appear small. Uridine and leptin were found to be disappointing so far. Regarding lipohypertrophy, diet and exercise, recombinant human growth hormone, and metformin may reduce visceral fat, but may worsen subcutaneous lipoatrophy. Surgical therapy may be required. Attractive pharmacologic treatments include growth hormone-releasing factor and leptin. Adiponectin and adiponectin receptors are promising therapeutic targets to explore.

Sculptra: the New Three-Dimensional Filler

Sculptra, the synthetic injectable poly-l-lactic acid (PLLA), is a revolutionary three-dimensional filler lasting 18 to 24 months. This unique volumizing agent is best used to globally restore volume to the lower two thirds of the face in patients who have lipoatrophy. Sculptra is a biocompatible, biodegradable, and nonimmunogenic derivative of the alpha-hydroxy-acid family. The size and the slow degradation kinetics of PLLA microparticles act as a stimulus for collagen production, providing lasting volume enhancement in lipoatrophy patients.

HIV-associated lipodystrophy syndrome: A review of clinical aspects

Approximately two years after the introduction of highly active antiretroviral therapy for the treatment of HIV infection, body shape changes and metabolic abnormalities were increasingly observed. Initially, these were ascribed to protease inhibitors, but it is now clear that nucleoside reverse transcriptase inhibitors also contribute to lipodystrophy syndrome. The syndrome groups together clinical conditions describing changes in body fat distribution that include lipoatrophy, lipoaccumulation or both. However, there does not appear to be a direct link between lipoatrophy and lipoaccumulation that would support a single mechanism for the redistribution of body fat. Currently, there is no clear definition of lipodystrophy, which explains the difficulty in determining its prevalence and etiology. There are no current guidelines for the treatment of fat distribution abnormalities that occur in the absence of other metabolic complications. The present article reviews the current state of knowledge of the definition, symptoms, risk factors, pathogenesis, diagnosis and treatment of the morphological changes associated with lipodystrophy syndrome.

HIV Lipodystrophy Syndrome: A Primer

Treatment with highly active antiretroviral therapy (HAART) has been implicated in the development of anthropomorphic and metabolic abnormalities termed HIV lipodystrophy syndrome (or LDS). This primer offers a comprehensive overview of LDS including epidemiology, hypothesized etiologies, and clinical consequences. The evidence-based literature is reviewed for current treatment strategies including discontinuation of specific antiretrovirals, pharmacological management of dyslipidemia and insulin resistance, exercise training, facial augmentation, liposuction, and hormonal therapy. Patient education, counseling, and adherence are discussed.

Use of Ultrasonography-Assisted Liposuction for the Treatment of Human Immunodeficiency Virus--Associated Enlargement of the Dorsocervical Fat Pad

Enlargement of the dorsocervical fat pad (i.e., "buffalo hump") is one manifestation of the lipodystrophy syndrome associated with human immunodeficiency virus. We report our experience with the use of ultrasonography-assisted liposuction in a cohort of 10 patients with this complication.

Soft tissue augmentation with artecoll: 10-year history, indications, techniques, and complications

Most of the biologic filler materials that increase the thickness of the corium in a wrinkle line are phagocytosed within a certain time. Therefore, a lasting effect can only be achieved with nonresorbable synthetic substances. Artefill consists of 20 volume percent microspheres of polymethyl-methacrylate and 80 volume percent of bovine collagen. Beneath the crease, the microspheres with their exceptional surface smoothness stimulate fibroblasts to encapsulate each individual one of the 6-million microspheres contained in 1 mL of Artefill. Collagen is merely a carrier substance that prevents the microspheres from agglomerating during tissue ingrowth. The 20 volume percent of microspheres in Artefill provides the scaffold for the 80% volume of connective tissue deposition, a complete replacement of the injected collagen. The filler material beneath a crease acts like a splint and prevents the possibility of its further folding, thereby allowing the diminished thickness of the corium in a crease to recover. This recovery process is well known even in older patients with facial paralysis or after a stroke, whose facial wrinkles and furrows on the paralyzed side disappear over time.

HIV-associated facial lipoatrophy

BACKGROUND

HIV-infected individuals are living long, healthy lives. They are now concerned with less life-threatening problems, especially lipodystrophy.

OBJECTIVE

To review the current state of our knowledge about lipodystrophy in HIV-infected individuals.

METHODS

The literature was reviewed and analyzed for relevant information. In addition, our clinical experience of managing such individuals was utilized.

RESULTS

Lipodystrophy and facial lipoatrophy and their relationship to HIV-infection are discussed. Their differences are noted. The spectrum of appearance in individuals with facial lipoatrophy is described and a severity scale suggested which should be of value in assessing the results of treatment.

CONCLUSION

Lipodystrophy and lipoatrophy are intimately related to infection with HIV. In consequence, facial lipoatrophy is a major stigma for HIV-infected individuals and can have dramatic effects on their self-esteem and socialization. Effective treatment is essential.

Maintenance of breast size reduction after mastoplasty and switch to a protease inhibitor-sparing regimen in an HIV-positive woman with highly active antiretroviral therapy-associated massive breast enlargement

Fat distribution disorders are among the most frequent side effects of antiretroviral treatment. The pathophysiologic mechanism(s) for these events remains unclear, and a casual link to a specific drug or class of drugs is uncertain. The physical changes associated with the lipodystrophy syndrome can be divided into three major types: lipoatrophy or fat wasting; lipohypertrophy or fat accumulation; and mixed forms with atrophy and hypertrophy coexisting in different body regions. Fat accumulation can occur in one or more of several areas including dorsal-cervical and abdominal regions and breasts. Withdrawal of antiretroviral therapy does not seem to influence the stabilized lesions significantly, and no one of the therapeutic strategies adopted so far was capable to achieve substantial improvements. Here we describe the successful and lasting treatment of a massive and movement/posture-hampering breast hypertrophy with reductive mastoplasty.