Lipohypertrophy due to HAART: a case series


  • Arikeri Vasu Deva Rao Department of Pharmacology, Kakatiya Medical College, Warangal 506007, Telangana, India
  • Samarasimha Reddy L. Department of Pharmacology, Kakatiya Medical College, Warangal 506007, Telangana, India
  • Srinivas Velupula Department of Pharmacology, Kakatiya Medical College, Warangal 506007, Telangana, India
  • Jayababu N. Department of Pharmacology, Kakatiya Medical College, Warangal 506007, Telangana, India
  • Imran Khan Department of Pharmacology, Kakatiya Medical College, Warangal 506007, Telangana, India
  • Kiran Kumar M. Department of Pharmacology, Kakatiya Medical College, Warangal 506007, Telangana, India



HAART, Lipodystrophy


A subset of HIV-1 infected patients undergoing Highly Active Antiretroviral Therapy (HAART) develops a lipodystrophy syndrome. It is characterised by loss of subcutaneous adipose tissue (face, limbs and buttocks) visceral fat accumulation and lipomatosis especially in dorsocervical area. In addition these patients show metabolic alteration implicative of metabolic syndrome particularly dyslipidaemia and insulin resistance. These alterations lead to enhanced cardiovascular risk and favour the development of diabetes in such patients. A complex combination of HIV infection, drug treatment related events and lipotoxicity appears to contribute to the development of lipodystrophy syndrome. Active lipolysis in subcutaneous fat combined with impaired storage capacity in subcutaneous depot leads to ectopic deposition of lipids either in visceral or in non-adipose sites. Lipotoxicity, a pathogenic factor in the lipodystrophy syndrome should be considered in the strategies for treating and /or preventing the morphological alterations and systemic metabolic disturbances associated with lipodystrophy.


Kumar O. Assessment of adverse drug reactions to antiretroviral agents among HIV patients. J App Pharmaceut Scien. 2018;8(02):079-82.

Bruton LL, Chabner BA, Knollman BC (Eds): Goodman and Gilman’s The Pharmacological Basis of Therapeutics: 13th Ed: McGRAW-Hill, New York; 2018:1137-1157.

Villarroya F, Domingo P, Giralt M. Lipodystrophy in HIV 1-infected patients: lessons for obesity research. Int J Obesi. 2007 Dec;31(12):1763.

WHO. Patient evaluation and anti retroviral treatment for adults and adoloscents, clinical protocol for the WHO European Region; 2012. Available at:

Lana LG, Junqueira DR, Perini E, de Pádua CM. Lipodystrophy among patients with HIV infection on antiretroviral therapy: a systematic review protocol. BMJ open. 2014 Mar 1;4(3):e004088.

Gkrania-Klotsas E, Klotsas AE. HIV and HIV treatment: effects on fats, glucose and lipids. British Medical Bulletin. 2007 Nov 2;84(1):49-68.

Mercier S, Gueye NF, Council A, Frontbonne A, Copin N, N diaye I, et al. Lipodystrophy and metabolic disorders in HIV-1 infeected adults on 4-9-year antiretroviral therapy in Senegal: a case control study. J Acquir Immune Defic Syndr.2009:51(2):224-30.

UNAIDS; 2017. Data Book [pdf]. Available at:

Global AIDS monitoring. Indicators for monitoring the 2016 United Nations Political Declaration on HIV and AIDS. Geneva: UNAIDS; 2017:85.

Lopez- Dupla PJM, Alba V, Beltran-Debon R, Martinez E, Domingo P, et al. HIV/Antiretroviral therapy-related Lipodystrophy Syndrome (HALS) is associated with higher RBP4 and lower omentin in plasma. Clin Microbiol Infect. 2015.

Dube MP, Komarow L, Mulligan K. Longterm body fat outcomes in antiretroviral-naive participants randomized to nelfinavir or efavirenz or both plus dual nucleosides. Dual X-ray abssorptiometry results from A5005s, a substudy of Adult Clinical Trials G roup 384. J Acquir Immune Defic Syndr. 2007;45(5):508-14. [PubMed :17589373].

Shikuma CM, Yang Y, Glesby MJ, Meyer III WA, Tashima KT, Ribaudo HJ, et al. AIDS Clinical Trials Group Protocol A5095 Study Team. Metabolic effects of protease inhibitor-sparing antiretroviral regimens given as initial treatment of HIV-1 Infection (AIDS Clinical Trials Group Study A5095). JAIDS. 2007 Apr 15;44(5):540-50.

Boyd MA, Carr A, Ruxrungtham K, Srasuebkul P, Bien D, Law M, et al. Changes in body composition and mitochondrial nucleic acid content in patients switched from failed nucleoside analogue therapy to ritonavir-boosted indinavir and efavirenz. The J Inf Diseas. 2006 Sep 1;194(5):642-50.

Katjung BG, Masrers SB, Trevor AJ (Eds). Basic and Clinical Pharmacology: 14th Edition, Lange, McGraw Hills, New York; 2018:870-884.

Villarroya F, Domingo P, Giralt M. Lipodystrophy associated with highly active anti-retroviral therapy for HIV infection: the adipocyte as a target of anti-retroviral-induced mitochondrial toxicity. Trends in Pharmacological Sciences. 2005 Feb 1;26(2):88-93.

Kratz M, Purnell JQ, Breen PA, Thomas KK, Utzschneider KM, Carr DB, et al. Reduced adipogenic gene expression in thigh adipose tissue precedes human immunodeficiency virus-associated lipoatrophy. The J Cli Endocrinol & Metaboli. 2008 Mar 1;93(3):959-66.

David E. Golan, Ehrin J Armstrong, April W. Armstrong Eds: Principles of Pharmacology: The pathological basis of disease: 4th Ed, Lippincott Williams and Wilkins, Philadelphia; 2017:705-717.

Caron-Debarle M, Lagathu C, Boccara F, Vigouroux C, Capeau J. HIV-associated lipodystrophy: from fat injury to premature aging. Trends in molecular medicine. 2010 May 1;16(5):218-29.

Perez-Matute P, Perez-Martinez L, Blanco JR, Oteo JA. Role of mitochondria in HIV infection and associated metabolic disorders: focus on nonalcoholic fatty liver disease and lipodystrophy syndrome. Oxidative medicine and cellular longevity. 2013 Jul 21;2013.

Tadesse TW, Mekonnen BA, Tesfaye TY. Self repoted adverse drug reactions and their influence on highly active antiretroviral therapy in HIV infected patients: a cross sectional study. BMC Pharmacology and Toxicology. 2014;15:32.

Gomes- Neotn M, Conceicao CS, Oliveira Carvalho V, Brites C. A systematic review of effects of different types of n therapeutic exercise on physiologic and functional measurements in patients with HIV/AIDS. Clincs (Soo Paulo). 2013;68(8):1157-67.

Lichtenstein K, Balasubramanyam A, Sekhar R, Freedland E. HIV-associated adipose redistribution syndrome (HARS): definition, epidemiology and clinical impact. AIDS research and therapy. 2007 Dec;4(1):16.

Tiliscan C, Aramă V, Mihăilescu R, Munteanu DI, Streinu-Cercel A, Ion DA, et al. Leptin expression in HIV-infected patients during antiretroviral therapy. Germs. 2015 Sep;5(3):92.

Srinivasa S, Wong K, Fitch KV, Wei J, Petrow E, Cypess AM, et al. Effects of lifestyle modification and metformin on irisin and FGF 21 among HIV‐infected subjects with the metabolic syndrome. Clinical endocrinology. 2015 May;82(5):678-85.

Lipodystrophy syndrome in HIV. Brazil. Ministry of Health. 2011. Available at: Accessed July 9, 2014.

Mercier S, Gueye NF, Cournil A, Fontbonne A, Copin N, Ndiaye I, et al. Lipodystrophy and metabolic disorders in HIV-1-infected adults on 4- to 9-yearantiretroviral therapy in Senegal: a case-control study. J Acquir Immune Defic Syndr. 2009;51(2):224-30.

Cournil A, Coudray M, Kouanfack C, Essomba CN, Tonfack CA, Biwole´-Sida M, et al. Reduced dose of stavudine and lipoatrophy in HIV-infected patients in Cameroon. Antivir Ther. 2010;15(7):1039-43.




How to Cite

Rao, A. V. D., Reddy L., S., Velupula, S., N., J., Khan, I., & Kumar M., K. (2018). Lipohypertrophy due to HAART: a case series. International Journal of Basic & Clinical Pharmacology, 7(8), 1662–1666.



Case Reports