Buffalo Hump in Lipodystrophy Syndromes

HIV-Associated Lipodystrophy

The American College of Cardiology recommends recognizing buffalo hump as a characteristic feature of HIV-associated lipodystrophy, which is an acquired form of lipodystrophy that occurs as a complication of antiretroviral treatment, presenting with distinctive fat redistribution patterns, including loss of subcutaneous fat, increase in intra-abdominal fat, buffalo hump, or breast hypertrophy 1
HIV-associated lipodystrophy appears in three prevalent forms: generalized or localized lipoatrophy, lipohypertrophy with generalized or local fat deposition, and mixed pattern with central adiposity and peripheral lipoatrophy, according to the American Heart Association 3
Increased duration of HIV infection, high viral load, and low CD4 counts before highly active antiretroviral therapy (HAART) are risk factors for HIV-associated lipodystrophy, as stated by the American College of Cardiology 4
Antiretroviral treatment, particularly protease inhibitors, is associated with HIV-associated lipodystrophy, though it can occur with other regimens as well, as noted by the Clinical Nutrition society 1

The American College of Cardiology states that increased duration of HIV infection is a risk factor for HIV-associated lipodystrophy 4
High viral load is a risk factor for HIV-associated lipodystrophy, according to the American Heart Association 4
Low CD4 counts before highly active antiretroviral therapy (HAART) is a risk factor for HIV-associated lipodystrophy, as stated by the Clinical Nutrition society 4

HAART-associated lipodystrophy normalizes resting energy expenditure but has only minor effects on lipolysis, as noted by the Clinical Nutrition society 1
The metabolic changes in HAART-associated lipodystrophy appear to be permanent, as discontinuation of HAART does not influence the degree of lipodystrophy, according to the Clinical Nutrition society 1

Familial partial lipodystrophy (particularly Dunnigan variety) may present with fat redistribution, though buffalo hump is not as characteristic as in acquired forms, as stated by the American Heart Association 4
Genetic lipodystrophy syndromes involve fat loss from extremities more than trunk, according to the American College of Cardiology 4

Medical treatment of lipodystrophy itself is generally not effective, as noted by the Clinical Nutrition society 1
Avoiding antiretroviral drugs with strong metabolic adverse effects may prevent or partially reverse lipodystrophy, according to the Clinical Nutrition society 1
Management should focus on screening for metabolic complications, such as insulin resistance and diabetes mellitus, as stated by the American College of Cardiology 1

When evaluating a patient with buffalo hump, consider HIV status and antiretroviral medication history, as recommended by the American College of Cardiology 1, 4
Assessment of body composition (dual-energy X-ray absorptiometry) to assess fat distribution patterns is recommended by the Clinical Nutrition society 2