Lipodystrophy in HIV Workup

Updated: Aug 13, 2021
  • Author: David T Robles, MD, PhD, FAAD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Approach Considerations

Human immunodeficiency virus (HIV)–associated lipodystrophy is a clinical diagnosis. Although there is not a specific clinical protocol to make the diagnosis, advancements have been made that can aid in the assessment of lipodystrophy. A 2014 cross-sectional European study showed that anthropometric ratios (fat-mass ratio, waist-to-thigh ratio, waist-to-calf ratio, and arm-to-trunk ratio) are useful in making the diagnosis of lipodystrophy. Incorporating this method can lead to an accurate and earlier diagnosis. [62]

The only relevant laboratory studies are serum lipid assays. A skin or subcutaneous fat biopsy is not routinely performed to make a diagnosis of HIV lipodystrophy. Imaging studies are not generally necessary in the workup of HIV lipodystrophy. Dual energy x-ray absorptiometry scanning, CT scanning, and MRI are limited to research studies to objectively quantify fat abnormalities. [63]

MRI demonstrates the accumulation of visceral fat in the abdomen compared with subcutaneous fat. CT scanning demonstrates abnormal fat proliferation throughout the abdomen in a perivisceral distribution and little subcutaneous fat. Intra-abdominal organs are normal, and no ascites is seen. Dual-energy x-ray absorptiometry may demonstrate lumbar spine bone density reduction in association with increased visceral fat accumulation. [64]

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Lipid Panel

Because abnormal glucose and/or lipid metabolism may accompany HIV lipodystrophy, checking the lipid panel and assessing for glucose intolerance is important prior to initiating antiretroviral therapy. Some experts suggest checking these values again at 6 months and then, if the results are normal, yearly.

Hyperlipidemia findings are as follows:

  • Fasting cholesterol level - Greater than 200 mg/dL
  • Fasting triglyceride level - Greater than 150 mg/dL
  • Increased apolipoprotein c-III and apolipoprotein E levels

Hyperglycemia and/or hyperinsulinemia findings are as follows:

  • Diabetes - Fasting plasma glucose level of greater than 126 mg/dL or a 2-hour oral glucose tolerance test result of greater than 200 mg/dL
  • Impaired fasting glucose - Fasting plasma glucose level of 100-125 mg/dL
  • Impaired glucose tolerance - Two-hour oral glucose tolerance test result of 140-199 mg/dL
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