title: Multidisciplinary approach to the treatment of metabolic and morphologic alterations of HIV-related lipodystrophy.
abstract: 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.
authors.affiliation: 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
authors.forename: Giovanni
authors.initials: G
authors.lastname: Guaraldi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Orlando
authors.forename: Nicola
authors.initials: N
authors.lastname: Squillace
authors.forename: Giorgio
authors.initials: G
authors.lastname: De Santis
authors.forename: Antonio
authors.initials: A
authors.lastname: Pedone
authors.forename: Antonio
authors.initials: A
authors.lastname: Spaggiari
authors.forename: Domenico
authors.initials: D
authors.lastname: De Fazio
authors.forename: Marcella
authors.initials: M
authors.lastname: Vandelli
authors.forename: Maria
authors.initials: M
authors.lastname: De Paola
authors.forename: Costantino
authors.initials: C
authors.lastname: Bertucelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Aldrovandi
authors.forename: Giulia
authors.initials: G
authors.lastname: Nardini
authors.forename: Barbara
authors.initials: B
authors.lastname: Beghetto
authors.forename: Vanni
authors.initials: V
authors.lastname: Borghi
authors.forename: Marco
authors.initials: M
authors.lastname: Bertolotti
authors.forename: Bruno
authors.initials: B
authors.lastname: Bagni
authors.forename: Maria
authors.initials: M
authors.lastname: Grazia Amorico
authors.forename: Alberto
authors.initials: A
authors.lastname: Roverato
authors.forename: Roberto
authors.initials: R
authors.lastname: Esposito
mesh_terms: 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
chemical_list: D019380:Anti-HIV Agents; D001055:Apolipoproteins B; D002784:Cholesterol; D005947:Glucose