Treatment strategies for HIV lipodystrophy.
OBJECTIVE
To review new potential treatment strategies for the peripheral subcutaneous lipoatrophy and relative central fat accumulation of HIV lipodystrophy.


RESULTS
HIV lipodystrophy was described almost 10 years ago, but treatment strategies are limited and until now have had only a modest impact on those already affected. The incidence of HIV lipodystrophy appears to be declining as a result of the use of newer antiretroviral drugs. Recent studies confirm that stavudine and zidovudine are the nucleoside analogues responsible for most lipoatrophy, but also suggest that different protease inhibitors have opposing effects on lipoatrophy. Thiazolidinediones, uridine and pravastatin may also improve lipoatrophy, although their effects have not been shown to be sustained. Metformin and growth hormone and its analogues are effective in reducing abdominal fat accumulation, although they aggravate lipoatrophy and generally have only transient effects. Cosmetic surgery can modestly improve facial lipoatrophy.


CONCLUSIONS
Antiretroviral regimens excluding stavudine and zidovudine offer substantial protection against lipoatrophy. Established lipoatrophy improves gradually with the cessation of these drugs. No medical intervention has been shown to have a sustained and substantial benefit on either lipoatrophy or visceral fat accumulation.
HIV, Immunology and Infectious Diseases Unit, St Vincent's Hospital, Sydney, Australia.
Andrew
A
Carr