Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy.
BACKGROUND
Treatment for metabolic and morphologic alterations in HIV-related lipodystrophy include medical therapy, physical exercise, and surgical interventions.


METHODS
We assessed the efficacy and safety of a comprehensive multidisciplinary approach for treating morphological and metabolic alterations of the lipodystrophy syndrome in consecutive patients attending the Metabolic Clinic (MC) of the University of Modena and Reggio Emilia who had at least 2 evaluations over a 48-week period. 245 patients were evaluated: 143 (62.4%) were men, 74 (36.1%) presented with lipoatrophy, 10 (4.9%) with fat accumulation, 93 (45%) with mixed forms, 24 (11.3%) had hypercholesterolemia (LDL >160 mg/dL), 87 (38%) had hypertriglyceridemia (TG >150 mg/dL), 13 (5.7%) had diabetes (glucose >126 mg/dL), and 78 (44%) had insulin resistance (HOMA-IR >4).


RESULTS
At follow-up, a significant improvement was observed in both objective and subjective variables. Anthropometric improvement was observed in waist to hip ratio, waist circumference, and right and left cheek dermal thickness measurements. A nonsignificant improvement was observed in fat and lean regional mass by DEXA; CT showed improvement in visceral and subcutaneous adipose tissue. Glucose, HOMA-IR, total cholesterol, and APO B improved. Subjective variables improved in aesthetic satisfaction.


CONCLUSIONS
We conclude that the medical and surgical interventions proposed in this multidisciplinary therapeutic approach are efficacious and safe in the management of lipodystrophy.
Guaraldi
Giovanni
G
Department of Medicine and Medical Specialties, Infectious Diseases Clinic, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100 Modena, Italy. g.guaraldi@unimo.it
Orlando
Gabriella
G
Squillace
Nicola
N
De Santis
Giorgio
G
Pedone
Antonio
A
Spaggiari
Antonio
A
De Fazio
Domenico
D
Vandelli
Marcella
M
De Paola
Maria
M
Bertucelli
Costantino
C
Aldrovandi
Cristina
C
Nardini
Giulia
G
Beghetto
Barbara
B
Borghi
Vanni
V
Bertolotti
Marco
M
Bagni
Bruno
B
Grazia Amorico
Maria
M
Roverato
Alberto
A
Esposito
Roberto
R
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001055:Apolipoproteins B / Q000097:blood; D050218:Body Fat Distribution; D002784:Cholesterol / Q000097:blood; D003131:Combined Modality Therapy; D003376:Counseling; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D005947:Glucose / Q000378:metabolism; D039682:HIV-Associated Lipodystrophy Syndrome / Q000097:blood / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013518:Surgery, Plastic; D016896:Treatment Outcome; D049629:Waist-Hip Ratio
D019380:Anti-HIV Agents; D001055:Apolipoproteins B; D002784:Cholesterol; D005947:Glucose