HIV-associated lipodystrophy syndrome

In recent years, lipodystrophy and its related complications have become one of the major problems confronting HIV-infected patients on antiretroviral therapy. More than ten years after having been described for the first time, comprehensive knowledge of its underlying molecular basis, the natural history of body fat changes and metabolic abnormalities, and even a working definition of lipodystrophy are all still lacking. No standardized objective assessment of body fat has been incorporated into clinical practice for patient monitoring. Although a huge amount of data has been generated, no clinically proven treatment for any feature of lipodystrophy is currently available. The only intervention that has been shown to reverse lipoatrophy had been the discontinuation of thymidine analogues, although even then the results obtained are at most partial or modest. Recently published studies using uridine (NucleomaxX) and pravastatin resulted in a significant increase of subcutaneous fat. The potential for reversing lipodystrophy once it has developed is limited, but promising results in preventing it are obtained with thymidine analogue-sparing initial antiretroviral regimens. These results raise the question of whether we may be facing a definitive solution to the lipodystrophy syndrome.