Background

Changes in body fat distribution are a frequent finding in individuals with HIV infection. Lipoatrophy, or decreased subcutaneous fat in the limbs together with prominent veins, loss of buttock fat and facial atrophy, can occur alone or in combination with fat accumulation, or lipohypertrophy, in other areas of the body, usually the abdomen and dorsocervical region. Central fat accumulation is usually due to visceral as opposed to subcutaneous fat and this, in association with peripheral wasting, initially led to characterization of the syndrome as ‘pseudocushing's syndrome’[5]. The true prevalence of HIVLD has been difficult to establish in the setting of a lack of consensus regarding definition. Although prevalence rates have varied widely [1, 6–8], it is estimated that together, lipohypertrophy, lipoatrophy and mixed abnormalities of body composition occur in more than 50% of antiretroviral-treated patients in cross sectional studies; these abnormalities have also been described in treatment naive individuals [5, 9, 10]. Prospective studies have shown that changes in body composition begin to occur shortly after initiation of combination antiretroviral therapy, with prevalence increasing with duration of therapy [11–13].