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Gluteal Augmentation in Patients with Lipodystrophy Due to the Use of Antiretroviral Therapy

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Abstract

With the introduction of effective antiretroviral therapy for the treatment of human immunodeficiency virus infection in 1996, there has been a surge of patients with body contour abnormalities that present with central fat accumulation and peripheral fat loss. Fortunately, there are many surgical approaches to help patients with these deformities. Loss of volume and projection, hip narrowing, widening of the intergluteal cleft, persistent dermatitis and ulcers characterize the gluteal deformities seen in these patients. A classification of gluteal lipoatrophy is presented in this chapter in order to adequately manage these patients. Silicone implants, autologous fat grafting and polymethyl methacrylate injections are among the most common procedures performed for these patients. There are several benefits for treating HIV-associated lipodystrophy beyond pure aesthetics. Changes in body morphology can be associated with psychological stress that can affect patients’ self-esteem and adherence to the medications. Therefore, plastic surgery procedures are highly indicated for patients presenting lipodystrophy caused by antiretroviral therapy.

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HIV-infected patients receiving antiretroviral therapy often develop changes in body fat distribution; the dominant change is reduction in sc adipose tissue (SAT). Because adipose tissue makes important hormones involved in whole-body energy metabolism, including leptin and adiponectin, we examined plasma concentrations and their relationship to regional adiposity measured by magnetic resonance imaging in 1143 HIV-infected persons (803 men and 340 women) and 286 controls (151 men and 135 women) in a cross-sectional analysis of the FRAM study. Total and regional adiposity correlated positively with leptin levels in HIV-infected subjects and controls (P < 0.0001). In controls, total and regional adiposity correlated negatively with adiponectin. In HIV-infected subjects, adiponectin was not significantly correlated with total adiposity, but the normal negative correlation with visceral adipose tissue and upper trunk SAT was maintained. However, leg SAT was positively associated with adiponectin in HIV-infected subjects. Within the lower decile of leg SAT for controls, HIV-infected subjects had paradoxically lower adiponectin concentrations compared with controls (men: HIV 4.1 microg/ml vs. control 7.5 microg/ml, P = 0.009; women: HIV 7.8 microg/ml vs. control 11.6 microg/ml, P = 0.037). Even after controlling for leg SAT, exposure to stavudine was associated with lower adiponectin, predominantly in those with lipoatrophy. The normal relationships between adiponectin levels and total and leg adiposity are lost in HIV-infected subjects, possibly due to changes in adipocyte function associated with HIV lipodystrophy, whereas the inverse association of adiponectin and visceral adipose tissue is maintained. In contrast, the relationship between adiposity and leptin levels appears similar to controls and unaffected by HIV lipodystrophy.
Impact of HIV infection and HAART on lipids in men
  • S A Riddler
  • E Smit
  • S R Cole
  • SA Riddler