Lawrence Kingsley, Dr. P.H., proposed the definition in Chicago at the 2001 Sessions of the International Association of Physicians in AIDS Care (IAPAC).
"Because there has been no formal definition of the HIV-associated lipodystrophy syndrome up to this point, the prevalence of reported cases of this condition have varied widely -- from less than 10 percent of HIV-infected persons to more than 80 percent," noted Dr. Kingsley, associate professor of infectious diseases and epidemiology at the University of Pittsburgh GSPH. "We are proposing a description of the syndrome that can guide physicians and other health care providers in properly diagnosing their patients."
HIV-LS involves changes in fat distribution throughout the body, along with cholesterol and glucose abnormalities, in HIV-infected individuals taking highly-active antiretroviral therapy (HAART) or antiretroviral therapy (ART), and in some people who are not on drug therapy but who have long-term HIV infection. The body-shape changes experienced by patients are dramatic and anxiety provoking, while the changes in lipids and glucose metabolism may increase their long-term risk of cardiovascular disease.
Signs of HIV-LS are a wasting, or a reduction in fat (lipoatrophy), in the face, arms, legs and buttocks; and an increase in fat (lipodystrophy) in the abdomen, back of the neck and breasts. The added abdominal fat is primarily visceral fat, which accumulates within the abdominal cavity, around the organs.
Dr. Kingsley's proposed definition of HIV-LS follows:
1. Peripheral Lipoatrophy only -- moderate or greater subcutaneous fat loss in two or more of the following areas: arms, legs, buttocks or face scored as mild, moderate or severe.
2. "Mixed" Lipodystrophy -- peripheral lipoatrophy (see 1. above) plus moderate or greater increased fat accumulation in the abdomen or breasts, with or without additional fat at the back of the neck.
3. Peripheral Lipoatrophy or Mixed Lipodystrophy along with metabolic abnormalities of glucose metabolism or lipids.
In monitoring HIV-infected individuals every three to six months, Dr. Kinglsey suggests that health care providers keep track of changes in height, weight, body-mass index, arm, thigh, waist, hip and waist-to-hip ratio using the standardized protocol.
Dr. Kingsley recommends dual energy X-ray absorptiometry (DEXA) scan for quantifying muscle, bone and fat in arms, legs and abdomen, and computed tomography (CT) or MRI to quantify and discriminate between visceral and subcutaneous fat.
In addition, Dr. Kingsley recommends the following fasting blood tests for metabolic abnormalities: cholesterol (total, HDL and LDL), triglycerides, HBA1c, glucose, insulin, apolipoprotein A and B, and lipoprotein A.
Dr. Kingsley's recommendations are based on clinical information gathered through the Multicenter AIDS Cohort Study (MACS), a National Institutes of Health-funded epidemiological study of HIV infection in homosexual men. The University of Pittsburgh GSPH is one of four sites nationwide participating in the MACS. Dr. Kingsley is co-principal investigator of the Pittsburgh-site, known locally as the Pitt Men's Study. MACS is currently in its 16th year of surveying the natural history of HIV.