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Drug-induced lipodystrophy
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Drug-induced lipodystrophy

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Contributors: Khanyisile Dladla MBChB, FCDerm, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Susan Burgin MD
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Synopsis

Lipodystrophy, or fat redistribution, is frequently seen in patients on long-term antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection.

The clinical manifestations include fat loss (lipoatrophy - on the face, extremities, and buttocks); fat gain (abdominal, dorsocervical, and breast lipohypertrophy); and mixed presentations (gain and loss).

The most commonly implicated ART drugs are nucleoside reverse transcriptase inhibitors, but protease inhibitors and, to a lesser extent, non-nucleoside reverse transcriptase inhibitors may less frequently be responsible.

Drug-induced lipodystrophy in patients with HIV on ART is associated with metabolic complications, an increased risk of cardiovascular disease, and pancreatitis.

Lipodystrophy can develop within months to 2 years after the initiation of ART, with changes in limb and waist circumference apparent in up to 35% of patients after 2 years of initiation of ART.

Oral corticosteroid therapy may also cause fat redistribution (both a cushingoid appearance and true, iatrogenic Cushing syndrome are possible). Lipohypertrophy or lipoatrophy can occur at insulin injection sites, and lipohypertrophy at pegvisomant injection sites has been reported.

Codes

ICD10CM:
E88.1 – Lipodystrophy, not elsewhere classified

SNOMEDCT:
713693008 – Lipodystrophy caused by antiretroviral drug

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Berardinelli-Seip syndrome and Seip-Lawrence syndrome are congenital and acquired forms, respectively, of total lipodystrophy, and both are associated with diabetes mellitus and hyperlipidemia. The abdomen may be protuberant in these disorders due to enlargement of the liver and spleen, but unlike HIV-associated lipodystrophy, areas of fat accumulation are not seen.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 12/04/2018
Last Updated: 12/04/2018
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Drug-induced lipodystrophy
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Drug-induced lipodystrophy : Buffalo hump, Buttocks, NRTI antiretroviral, Cheeks
Clinical image of Drug-induced lipodystrophy
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