Lipodystrophy: lack of agreement on definition and etiology presents a challenge to research and therapy

“I can’t define it, but I know it when I see it,” said Supreme Court Justice Potter Stewart when asked to define pornography. The sentiment of this response can be applied equally to lipodystrophy.

Definitions of the lipodystrophy syndrome have proliferated more rapidly than successful treatments, adding confusion to an already complex area. It is now more than four years since the widespread recognition of the metabolic and morphologic changes observed during antiretroviral therapy. The morphologic changes can be highly stigmatising, and the metabolic manifestations may contribute to a range of morbidities. Anxiety about developing lipodystrophy may lead to risking HIV disease progression through delaying the commencement of therapy or deciding to stop therapy to prevent or manage the problems, and to risking long-term management through modification of established therapy to alternative regimens.