Before effective antiretroviral therapy (ART) became available, patients with advanced acquired immunodeficiency syndrome had devastating losses and their metabolic profile was characterized by reduced cholesterol levels. Since introduction of ART, numerous studies have reported changes in body composition with accumulation of central fat and loss of peripheral fat. The term “human immunodeficiency virus (HIV)-associated lipodystrophy syndrome” was then coined, which was soon recognized as several phenotypes that varied from person to person, rather than a unique syndrome. While some individuals had solely lipoatrophy, others had fat accumulation with varied presentation or a mixed condition of the two morphological patterns.

Lipoatrophy involves loss of subcutaneous fat in the face, arms, legs, abdomen, and buttocks. Abdominal fat accumulation is featured mainly by excess visceral fat and consequent increased waist circumference, but also in the dorsal cervical region (“buffalo hump”), trunk, breasts (in both women and men), and lipomas of the upper extremities.

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