Lipodystrophy and human immunodeficiency virus infection

Human immunodeficiency virus (HIV)/acquired human immunodeficiency syndrome (AIDS) is a major public health problem worldwide, since it is the number one leading cause of death in certain underdeveloped countries. Although many anti-HIV drugs, which dramatically decrease morbidity and mortality associated with HIV/AIDS, are available in developed countries, long-term use of these drugs has been associated with the undesirable side effect of lipodystrophy, a very hot issue over the past 2-3 years in those countries. This review includes the following: 1) a review of the epidemic of HIV/AIDS in Taiwan as well as worldwide; 2) a definition, classification, and the characteristics of lipodystrophy; 3) the prevalence of lipodystrophy in people living with HIV (PLWH); 4) factors associated with lipodystrophy in PLWH such as HIV, antiretroviral drugs including protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTIs), non nucleoside reverse transcriptase inhibitors (NNRTIs), and other drugs; the duration of drug therapy and drug tolerability, gender, body mass index (BMI) and body composition, age, immunity, hormones, diet/nutrition, and exercise; 5) the influence of lipodystrophy on PLWH; and 6) treatments for lipodystrophy including switching therapies or stopping drugs, diet/nutrition therapies, exercise, drug therapies to lower blood lipid or glucose, hormonal therapy, and plastic surgery such as liposuction, lipectomy or fat grafts. For those with dyslipidemia, hyperglycemia, insulin resistance, or diabetes mellitus, in addition to the therapies of diet/nutrition and exercise, blood lipid- or glucose-lowering drugs can be used.