Lipodystrophy: The Metabolic Link of HIV Infection with Insulin-Resistance Syndrome

Human lipodystrophies are a heterogeneous group of diseases characterized by generalized or partial fat loss. If localized, they are often associated with fat hypertrophy in other depots, varying according to the type of lipodystrophy. Lipodystrophies can be genetic, which is usually uncommon, or acquired. Genetic lipodystrophy is generally related to severe meta‐ bolic alterations including insulin resistance (IR) and its associated complications, such as glucose intolerance and diabetes, dyslipidemia, hepatic steatosis, polycystic ovaries, acan‐ thosis nigricans and early cardiovascular (CV) complications [1, 2]. The autosomal recessive congenital generalized lipodystrophy (CGL) and autosomal dominant familiar partial lipo‐ dystrophy (FPL) are the two most common types of genetic lipodystrophy [2]. Lipodystro‐ phies have been reported in the medical literature for more than 100 years [2, 3]. However, only 13 years ago, new lipodystrophy syndromes were recognized, being associated with vi‐ ral infection, specifically with the human immunodeficiency virus, in patients treated with combined antiretroviral therapy (cART) [4]. This has become the most frequent form of lipo‐ dystrophy [2]. Some first-generation antiretroviral drugs used in HIV patients are strongly related with peripheral lipoatrophy and metabolic alterations [1].