From lipodystrophy to cardiovascular disease: new insight into the management of HIV infection

In this era of highly active antiretroviral therapy (ART), body habitus changes among HIV-infected patients, including face and peripheral lipoatrophy, visceral abdomen fat accumulation, together with lipid and glucose metabolism abnormalities, have been widely described under the name of lipodystrophy. Lipodystrophy contributes to cardiovascular disease risk in HIV infection through a complex interplay of host, virus and ART factors. Given that both HIV and ART are independent risk factors for cardiovascular disease, aggressive preventive care should be considered in all infected patients. The time has come to proceed beyond lipodystrophy studies based on blood concentrations of lipids and glucose and body fat evaluation. Surrogate markers of organ disease associated with lipodystrophy identify patients vulnerable to cardiovascular events better than statistical risk algorithms. Management of lipodystrophy needs to be considered as being part of a multidisciplinary approach focusing on the reduction of cardiovascular diseases. For now, the mainstays of cardiovascular disease prevention for HIV-infected persons at high risk include, appropriate lifestyle changes, use of lipid-lowering and anti-aggregant medications and judicious selection of highly active ART agents.