ABSTRACT
Current treatment regimens for HIV infection are based on pharmacological intervention with nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI), which act to constrain HIV viral replication and reduce systemic viral load (Hammer et al., 1997). To enhance their potency these medications are generally prescribed in combination under the term ‘Highly Active Anti-Retroviral Therapy’ (HAART). Adherence to these therapies has been causally linked with the development of various metabolic disorders and alterations in body morphology in both paediatric and adult populations (Hengel et al., 1997; Carr et al., 1998; Babl et al., 2002; Tsiodras et al., 2000; van de Valk et al., 2001; Amaya et al., 1999). Some questioned the validity of this causal relationship given reported lipodystrophy in the absence of HAART therapy (Kotler, 2000; Saint-Marc et al., 2000). Irrespective of the controversy, patients on ‘HAART' typically present with a combination of symptoms including hyperlipidaemia, insulin resistance, osteopenia and adipose tissue wasting and/or redistribution, collectively termed lipodystrophy syndrome (Carr et al., 1998; Carr et al., 1999). Rather than be seen a single entity, at least several lipodystrophic phenotypes are expressed, e.g. lipodystrophy with subcutaneous lipoathrophy from the periphery (arms, legs) and fat pads of the face (Ho et al., 1999). A mixed lipodystrophy with lipoathrophy and adipose tissue redistribution is evidenced by enlargement of the dorsocervical fat pad (buffalo hump) and visceral abdominal adiposity development (Miller et al., 1998; Lo et al., 1998; Saint-Marc et al., 2000; Martínez et al., 2001a). These morphological phenotypes are empirically associated with the aetiological progression of accompanying metabolic disturbances (Saint-Marc et al., 2000; Heath et al., 2001; Kosmiski et al., 2001; Estrada et al., 2002), although this association between lipodystrophy-related body morphology changes and metabolic abnormalities has not always been supported by research (Mulligan et al., 2000; Rakotambinina et al., 2001).
