Lipoatrophy refers to the localized or generalized loss of subcutaneous fat, most noticeably in the face, buttocks, or limbs. This leads to a sunken, wasted appearance and can significantly affect self-image.
It is often part of a wider lipodystrophy syndrome, which involves abnormal fat redistribution (loss in some areas, accumulation in others such as dorsocervical "buffalo hump" or visceral fat).

⚠️ Causes

HIV Therapy: Especially linked with older antiretroviral regimens, notably protease inhibitors (PIs) and some nucleoside reverse transcriptase inhibitors (NRTIs, e.g. stavudine, zidovudine). These interfere with adipocyte mitochondrial function and lipid metabolism.
Renal Disease: Particularly membranoproliferative glomerulonephritis, often associated with complement abnormalities (low C3). This may take years to manifest after the onset of lipodystrophy.
Other rare causes: autoimmune disease, panniculitis, or post-injection atrophy (e.g. insulin injections).

🔍 Investigations

📌 Clinical diagnosis is key — based on redistribution of body fat in an HIV-positive patient on HAART.
🧪 Complement studies: Especially C3, to evaluate renal disease associations.
🧬 Consider genetic testing if familial/generalized lipodystrophy is suspected.
🩺 Monitor for associated metabolic complications: insulin resistance, diabetes, hyperlipidaemia, and cardiovascular risk.

💊 Management

🔄 Switching HAART Regimen: Modern ART regimens (integrase inhibitors, newer PIs) have lower risk — discuss regimen modification with an HIV specialist.
💉 Cosmetic/Surgical interventions: Dermal fillers (poly-L-lactic acid, hyaluronic acid) or autologous fat transfer can restore facial volume and improve quality of life.
🏃 Lifestyle interventions: Exercise and dietary optimization to manage metabolic complications.
💊 Medical therapy (experimental/limited use): Leptin analogues and insulin-sensitizing agents (metformin, thiazolidinediones) have been tried in generalized lipodystrophy with variable success.
🧠 Psychological support: Counseling to address stigma, self-esteem issues, and adherence to ART.

📚 Key Exam Pearls

Most exam questions link lipoatrophy to HIV patients on older PIs/NRTIs.
Always think of renal disease associations (low C3, MPGN) when lipoatrophy coexists with nephropathy.
Management is supportive — cosmetic repair + ART modification are the mainstays.

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Lipoatrophy

🧾 About

⚠️ Causes

🔍 Investigations

💊 Management

📚 Key Exam Pearls

Categories