In HIV-associated lipodystrophy syndrome, which fat distribution pattern is most characteristic?

• A. Visceral adipose tissue loss
• B. Not observed in patients on HAART
• C. Selective subcutaneous adipose tissue loss
• D. Seen mostly in patients younger than 40 years old

Answer: (C)

Subcutaneous fat loss in HIV-associated lipodystrophy is the defining pattern. Long-term HAART commonly causes lipoatrophy of the face, arms, legs, and buttocks, while central fat may accumulate (abdominal fat and dorsocervical fat pad). This makes selective loss of subcutaneous adipose tissue the best description of the characteristic pattern. Visceral fat loss is not typical and, in fact, central fat gain is common. Lipodystrophy is indeed associated with HAART, not something seen only in those not on therapy, and it is not restricted to people younger than 40.