1 A.

Lipodystrophy is a problem with the way the body produces, uses, and
stores fat. It is also called fat redistribution. Since the widespread use of
antiretroviral therapy began, the numbers of HIV-positive people with
lipodystrophy has increased. Today, lipodystrophy occurs in 30% to 50% of
people who are infected with HIV (human immunodeficiency virus).
Abnormalities of Lipodystrophy :
1. Fat buildup or fat redistribution (lipohypertrophy,
lipoaccumulation, or hyperadiposity) is when fat accumulates in
certain areas of the body Some people see the amount of
visceral fatfat deep within the bodyaround their gut
increase significantly. The medical term for this
is lipohypertrophy (excessive fat growth). Increased
dorsocervical fat padsa buildup of fat on the back of the neck
and shoulders (sometimes called "buffalo hump")has also
been seen, as well as increased fat tissue in the breasts. Some
people have also reported round, moveable, flattened lumps of
fat under the skin (lipomas).

Abdomen (central obesity)

Breasts (occurs in both men and women)
Back of neck and shoulders (sometimes called a "buffalo hump")
Fatty growths in different parts of the body (called lipomas)

2. Insulin resistance Obesity is characterized by increased body

adiposity and leads to insulin resistance. Paradoxically, some
conditions characterized by a paucity of fat also cause insulin
resistance, namely the syndromes of lipoatrophy. The
resemblance between the metabolic abnormalities of these
extreme states of adiposity underscores the importance of fat
tissue in energy homeostasis.
3. High levels of fats in the blood or abnormal blood lipid
Some people have an increased amount of fat, or lipids, in
their blood. The two types of lipids that increase are
triglycerides and cholesterol. Increased cholesterol levels can
increase the risk of a heart attack or stroke. Increased
triglycerides can increase the risk of damage to the pancreas
(pancreatitis).

Its typical pattern:

A pot belly
Buffalo bump
Breast enlargement
Tissue lipomas
Low HDL
Hypertriglyceridemia
Hyperinsulinemia

1 B.

LIFESTYLE:
1. Physical activity/resistance training

Lifestyle modification ( diet, exercise). Exercise is also recommended

although consistent changes in plasma lipids will not be seen in the
short-term. Regular exercise should be encouraged to improve
metabolic status. Lifestyle modifications alone may not be sufficient
and may need to be implemented along with pharmacotherapy

2. Dietary management

A diet with:
high protein,
trans-fat and less fiber
A Mediterranean diet,
high in omega-3,
fresh fruit and
vegetables and fiber.
A balanced low-fat
Low-carbohydrate diet is preferable since hypertriglyceridemia
in the patient.

TREATMENT:

1. HAART: HAART induced adipocyte inflammation, oxidative stress

and macrophage infiltration, as well as altered adipocyte function and
mitochondrial toxicity, have been shown to be central to the
development of HIV-associated lipodystrophy syndrome (HALS. )
2. APPETITE STIMULANT

MEGESTEROL :
Megestrol can be used as an appetite stimulant for people experiencing
loss of appetite and weight loss Megestrol may help relieve bone pain, and
it can improve appetite andweight gain.
DRONABINOL :
Dronabinol is a man-made form of cannabis (also known as
marijuana).Dronabinol is also used to treat loss of appetite and weight loss
in patients with HIV infection.

3. TESTOSTERONE AND HUMAN GROWTH HORMONE

This HUMAN GROWTH hormone generates some changes in our body: it decreases fat
mass and increases muscle mass. Testosterone also decreases body fat, increases
lean body mass and increases endurance .