Practical Review of Recognition and Management of Obesity and Lipohypertrophy in Human Immunodeficiency Virus Infection

Abstract

Background: Obesity and lipohypertrophy are common in treated human immunodeficiency virus (HIV) infection and contribute to morbidity and mortality among HIV-infected adults on antiretroviral therapy (ART).

Methods: We present a consensus opinion on the diagnosis, clinical consequences, and treatment of excess adiposity in adults with treated HIV infection.

Results: Obesity and lipohypertrophy commonly occur among HIV-infected adults on ART and may have overlapping pathophysiologies and/or synergistic metabolic consequences. Traditional, HIV-specific, and ART-specific risk factors all contribute. The metabolic and inflammatory consequences of excess adiposity are critical drivers of non-AIDS events in this population. Although promising treatment strategies exist, further research is needed to better understand the pathophysiology and optimal treatment of obesity and lipohypertrophy in the modern ART era.

Conclusions: Both generalized obesity and lipohypertrophy are prevalent among HIV-infected persons on ART. Aggressive diagnosis and management are key to the prevention and treatment of end-organ disease in this population and critical to the present and future health of HIV-infected persons.

Keywords: antiretroviral therapy.; human immunodeficiency virus (HIV); lipohypertrophy; obesity.

Figure 1.

Central role of the adipocyte in multisystem disease. Abbreviations: AT1/AT2, angiotensin II receptor type I/II; GLUT4, glucose transporter type 4; IRS1/2, insulin receptor substrate 1/2; MCP-1, monocyte chemoattractant protein 1; NO, nitric oxide; PAI-1, plasminogen activator inhibitor 1; PPAR-γ, peroxisome proliferator-activated receptor-γ; TNF-α, tumor necrosis factor α. Adapted with permission from Macmillan Publishers Ltd, Kidney Int 2008;74(7):851–3.