HIV – why is lipodystrophy less common in Africa?

[9 April 2010 - 10h09]

Lipodystrophy, a morphological disorder of the body’s adipose (fat) tissue – which therefore also includes cellulite – takes on a more serious dimension when associated with HIV infection. It is common among HIV sufferers and, according to the “AIDS information, discussion and exchange website http://www.vih.org negative impact”. Although little is known about the cause, these disorders also appear to be less common among African patients. However, reality can be quite different from appearance and our knowledge in this field needs to be developed.

“Little is known about lipodystrophy and, in particular, what causes it. Different factors play a part: HIV itself – a low CD4 level seems to favour lipodystrophy; the effects of treatment, etc” (highly active antiretroviral treatments can in fact often be linked to the development of spectacular cases of lipodystrophy: ed. note); but another factor appears to be being of a white race. Alexandra Calmy of Geneva University Hospital believes that there are more unknowns than knowns when it comes to this condition!

However, the knowns are very real and very worrying because the impact of lipodystrophy goes far beyond the psychological and aesthetic. While 77% of sufferers are offered cosmetic surgery, many other routes are also explored for remedying this disorder: changing the antiretroviral protocol (55% of cases); psychological (54%) or dietary (53%) follow-up; endocrinological treatment (68%), etc. Nevertheless, lipodystrophy, particularly when it leads to abdominal obesity, is a major cause of cardiovascular death.

So is lipodystrophy uncommon? Not at all. In Canada, for example, the authorities recognise that it is likely to affect “around 50% of people living with HIV during the first 3 years of treatment. (And) it is impossible to predict who will be affected before the start of treatment”. In Geneva, the university hospital’s dermatology department has in fact opened an out-patient centre specifically for this condition.

But if lipodystrophy is so common in the North, why should it be so much less common in the countries of the South? In Senegal, “only” 31% of HIV patients have moderate or severe lipodystrophy. And the figure is only 30% in Benin, although 35% of patients appear to be affected by cholesterol problems. A group studied in Rwanda showed only 34% lipodystrophy sufferers. These differences between the countries of the South and North offer ample opportunity for research. They also require that the risk be addressed and clinically managed globally… and early.

Source : from our special correspondent at the 5th Francophone HIV/AIDS Conference, Casablanca, 28-31 March 2010; Lipodystrophy: information for people living with HIV, Ministry of Health and Social Services, Quebec Province, Canada.

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