Pubic lipomas: a new manifestation of lipodystrophy?

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Researchers at a clinic for HIV-related metabolic concerns in northern Italy have reported what may be a newly recognized type of body fat abnormality in HIV-positive people with lipodystrophy. Pubic lipomas – bulbous fatty swellings in and around the pelvic region – have been seen in a significant number of men and women being followed at the clinic. This finding was reported in the May 1st issue of the Journal of Acquired Immune Deficiency Syndromes.

The metabolic clinic of the University of Modena and Reggio Emilia, Italy, provides treatment and conducts research into lipodystrophy-related concerns for HIV-positive individuals across Italy. This cross-sectional observational study evaluated 582 patients (214 women and 368 men) seen at the clinic between June 2005 and March 2006. All were 18 years or older, Caucasian, and all had confirmed lipodystrophy diagnoses by the Multicenter AIDS Cohort Study (MACS) definition.

Abnormal fat accumulations can occur as part of the HIV lipodystrophy syndrome. These typically occur in the belly and trunk, as enlarged breasts in women, and as dorsocervical fat pads (“buffalo humps”) – fat deposits at the base of the neck between the shoulder blades.

Glossary

lipodystrophy

A disruption to the way the body produces, uses and distributes fat. Different forms of lipodystrophy include lipoatrophy (loss of subcutaneous fat from an area) and lipohypertrophy (accumulation of fat in an area), which may occur in the same person.

body mass index (BMI)

Body mass index, or BMI, is a measure of body size. It combines a person's weight with their height. The BMI gives an idea of whether a person has the correct weight for their height. Many BMI calculators can be found on the internet.

syndrome

A group of symptoms and diseases that together are characteristic of a specific condition. AIDS is the characteristic syndrome of HIV.

 

observational study

A study design in which patients receive routine clinical care and researchers record the outcome. Observational studies can provide useful information but are considered less reliable than experimental studies such as randomised controlled trials. Some examples of observational studies are cohort studies and case-control studies.

metabolism

The physical and chemical reactions that produce energy for the body. Metabolism also refers to the breakdown of drugs or other substances within the body, which may occur during digestion or elimination.

In this study, pubic lipomas were graded as moderate if they were “readily noticeable by the patient or physician when the patient was naked”, and severe if “readily noticeable to a casual observer, even when the patient was dressed.” By these definitions, moderate or severe pubic lipomas were seen in 54 (9.4%) of the observed patients: 28 women and 26 men.

The lipomas were more common in people with higher body mass index (BMI): the prevalence was 8% in those who were not obese, but 34.5% in obese individuals (defined as those with a BMI greater than 30). They were also more likely in people with preexisting “buffalo humps” (18.5% vs. 6.1%; p

Logistic regression analysis identified the following risk factors: obesity (BMI > 30: β=0.18, p

The study was limited by not having a clear clinical definition of pubic lipoma using more sophisticated diagnostics, by not having a larger prospective cohort, and by not having an HIV-negative control group – limitations which the authors hope to address in subsequent studies. However, the authors “believe that the robustness of [their] findings, particularly a 9.4% prevalence rate… underscore[s] their significance”, and “suggest that [pubic lipomas] be considered part of the HIV-associated lipodystrophy syndrome.”

Reference>

Guaraldi G et al. Prevalence of and risk factors for pubic lipoma development in HIV-infected persons. J Acquir Immune Defic Syndr 45: 72-76, 2007.