Lipodystrophy

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Lipodystrophy is a rare clinical condition charaterised by degradation, degeneration and redistribution of fat throughout the body. The term lipodystrophy is derived from two Greek words "lipo" meaning "fat" and "dystrophy" meaning "degeneration". It can have two results lipoatrophy and lipohypertrophy (hyperadiposity).

What is lipoatrophy?

In contrast to lipodystrophy which is loss or redistribution of body fat stores, lipoatrophy is a condition characterized by loss of fat from a single area of human body. Most commonly the face is involved in such cases, however, it can involve any site.

What is lipohypertrophy?

It is basically fat accumulation on different parts of the body like belly, breasts and buttocks.

What are the different types of lipodystrophy?

Lipodystrophy is classified into congenital and acquired types.

u Congenital lipodystrophy

  • Familial lipodystrophy (partial)
  • Generalized lipodystrophy

u Acquired lipodystrophy

  • Partial
  • Generalized
  • Localized
  • HIV-associated
  • Centrifugal abdominal lipodystrophy
  • Lipoatrophia annularis
  • Medication associated (Insulin injections)

What are the common causes of lipodystrophy?

Previously, numerous studies showed that Protease Inhibitors are responsible for causing lipodystrophy. However, recent studies reveal that lipodystrophy can occur in individuals who have never taken Protease inhibitors. Lipodystrophy can also occur by the combined usage of Protease inhibitors and nucleoside reverse transcriptase inhibitors.

What are other risk factors for lipodystrophy?

u Lipodystrophy is more common in whites as compared to blacks.

u Moreover, elderly people are at higher risk of developing lipodystrophy.

u Males lose fat, whereas females deposit fat on abdomen and breasts.

u Obesity is another risk factor to have liposytrophy.

u As the duration of HIV infection increases chances of developing lipodystrophy increases.

What is HIV-associated lipodystrophy?

HIV-associated lipodystrophy is a syndrome that occurs in individuals infected with human immunodeficiency virus (HIV) and being treated with antiretroviral agents.

How lipodystrophy is caused by insulin injection?

Insulin is usually administered on the abdomen because of its high fat content. Lipodystrophy is a well known side effect of insulin. So, people using insulin have multiple dents on their abdomen showing marks of lipoatrophy (loss of fat). This can be avoided by frequently changing the site of injection.

What are the manifestations of lipodystrophy?

Lipodystrophy can manifest in two forms; lipohypertrophy or lipoatrophy. In lipohypertrophy there is accumulation of fat on various body parts and it manifests as swelling or lumps. In lipoatrophy there are dents on various body parts from where the fat is lost.

What is lipodystrophy syndrome?

Lipodystrophy may be associated with certain metabolic disorderslike hyperglycemia (insulin resistance) and hyperlipidemia. This is known as lipodystrophy syndrome. People suffering from lipodystrophy may be associated with lactic acidosis.

What is the treatment of lipodystrophy?

so far, no well known treatment modality is present for lipodystrophy. However, clinicians recommend few treatments which are;

u Lifestyle modification - this includes doing physical exercise daily and modifying the diet. Diet should include more muscle and less fat if the patient is suffering from lipohypertrophy.

u Avoiding antiretroviral therapy or switching from protease inhibitors to nucleoside reverse transcriptases inhibitors may also help in this regard.

u Injections of human chorionic gonadotropin (hCG) may be used to increase muscle mass.

u Several injections of synthetic fats are also used in cases of lipoatrophy to fill the rests and dents made due to fat loss

REFERENCES

http://en.wikipedia.org/wiki/Lipodystrophy

http://www.aidsinfo.nih.gov/ContentFiles/Lipodystrophy_FS_en.pdf

Robbin's Basic Pathology 8th edition

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Author: Dr Ahmad

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