title: HIV/AIDS and lipodystrophy: implications for clinical management in resource-limited settings.
abstract: BACKGROUND
  Lipodystrophy is a term used to describe a metabolic complication of fat loss, fat gain, or a combination of fat loss and gain, which is associated with some antiretroviral (ARV) therapies given to HIV-infected individuals. There is limited research on lipodystrophy in low- and middle-income countries, despite accounting for more than 95% of the burden of HIV/AIDS. The objective of this review was to evaluate the prevalence, pathogenesis and prognosis of HIV-related lipoatrophy, lipohypertrophy and mixed syndrome, to inform clinical management in resource-limited settings.
  
  
  METHODS
  We conducted a structured literature search using MEDLINE electronic databases. Relevant MeSH terms were used to identify published human studies on HIV and lipoatrophy, lipohypertrophy, or mixed syndrome in low-, low-middle- and upper-middle-income countries through 31 March 2014. The search resulted in 5296 articles; after 1599 studies were excluded (958 reviews, 641 non-human), 3697 studies were extracted for further review. After excluding studies conducted in high-income settings (n=2808), and studies that did not meet inclusion criteria (n = 799), 90 studies were included in this review.
  
  
  CONCLUSIONS
  Of the 90 studies included in this review, only six were from low-income countries and eight were from lower middle-income economies. These studies focused on lipodystrophy prevalence, risk factors and side effects of antiretroviral therapy (ART). In most studies, lipodystrophy developed after the first six months of therapy, particularly with the use of stavudine. Lipodystrophy is associated with increased risk of cardiometabolic complications. This is disconcerting and anticipated to increase, given the rapid scale-up of ART worldwide, the increasing number and lifespan of HIV-infected patients on long-term therapy, and the emergence of obesity and non-communicable diseases in settings with extensive HIV burden.
  
  
  CONCLUSIONS
  Lipodystrophy is common in resource-limited settings, and has considerable implications for risk of metabolic diseases, quality of life and adherence. Comprehensive evidence-based interventions are urgently needed to reduce the burden of HIV and lipodystrophy, and inform clinical management in resource-limited settings.
authors.affiliation: Division of Nutritional Sciences, Cornell University Ithaca, NY, USA; St. John's Research Institute, Bangalore, India; jfinkelstein@cornell.edu.
authors.forename: Julia L
authors.initials: JL
authors.lastname: Finkelstein
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Gala
authors.affiliation: Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Rochford
authors.affiliation: Division of Infectious Diseases, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Marshall J
authors.initials: MJ
authors.lastname: Glesby
authors.affiliation: Division of Nutritional Sciences, Cornell University Ithaca, NY, USA; St. John's Research Institute, Bangalore, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mehta
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D019380:Anti-HIV Agents / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006295:Health Resources; D006801:Humans; D008060:Lipodystrophy / Q000139:chemically induced* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008297:Male
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; HIV; antiretroviral therapy; fat redistribution; lipodystrophy