Lipodystrophy in HIV : Evolving Challenges and Unresolved Questions
Girlat, Marta (Instituto de Salud Carlos III)
Domingo Pedrol, Pedro (Institut de Recerca Sant Pau)
Quesada-López, Tania (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Cereijo, Rubén (Instituto de Salud Carlos III)
Villarroya, Francesc (Instituto de Salud Carlos III)
Universitat Autònoma de Barcelona. Departament de Medicina

Data:	2025
Resum:	The advent of effective antiretroviral therapy in the mid-1990s, which successfully prevented the progression to AIDS in people living with HIV (PLWH), was associated with the appearance of the so-called HIV-associated lipodystrophy. This condition involved subcutaneous fat atrophy; abdominal fat hypertrophy; and, in some cases, lipomatosis. It was also associated with systemic metabolic disturbances, primarily insulin resistance and dyslipidemia. Following the replacement of certain antiretroviral drugs, particularly the thymidine-analog reverse transcriptase inhibitors stavudine and zidovudine, with less toxic alternatives, the incidences of lipoatrophy and lipomatosis significantly declined. However, lipodystrophy resulting from first-generation antiretroviral therapy does not always resolve after switching to newer agents. Although the widespread use of modern antiretroviral drugs-especially integrase strand transfer inhibitors and non-lipoatrophic reverse transcriptase inhibitors such as tenofovir alafenamide-has reduced the incidences of severe forms of lipodystrophy, these regimens are not entirely free of adipose tissue-related effects. Notably, they are associated with weight gain that resembles common obesity and can have adverse cardiometabolic consequences. Recent evidence also suggests the hypertrophy of specific fat depots, such as epicardial and perivascular adipose tissue, in PLWH on last-generation treatments, potentially contributing to increased cardiovascular risk. This evolving landscape underscores the persistent vulnerability of PLWH to adipose tissue alterations. While these morphological changes may not be as pronounced as those seen in classic HIV-associated lipodystrophy, they can still pose significant health risks. The continued optimization of treatment regimens and the vigilant monitoring of adipose tissue alterations and metabolic status remain essential strategies to improve the health of PLWH.
Ajuts:	Instituto de Salud Carlos III PI20/00137 Instituto de Salud Carlos III PI20/00106
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article de revisió ; recerca ; Versió publicada
Matèria:	HIV ; Antiretroviral treatment ; Lipoatrophy ; Lipodystrophy ; Lipomatosis ; Obesity
Publicat a:	International journal of molecular sciences, Vol. 26, Num. 14 (July 2025) , art. 6546, ISSN 1422-0067

DOI: 10.3390/ijms26146546
PMID: 40724797

15 p, 935.6 KB

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