Body fat redistribution (BFR) syndrome, sometimes called fat derangement, is a medical condition characterized by fat loss (or occasionally fat gain), often in the cheeks or face. BFR most often occurs in HIV

HIV

Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...

/AIDS

AIDS

Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...

 patients undergoing antiretroviral therapy.

Definition

No firm definition of body fat redistribution syndrome exists as yet. At least four syndromes have been described that are characterized by the accumulation of fat, and one by the loss of fat; combinations of these may occur in an individual. Gender, age, and pre-therapy body weight appear to influence the severity of BFR in patients. BFR is distinct from lipodystrophy

Lipodystrophy

Lipodystrophy is a medical condition characterized by abnormal or degenerative conditions of the body's adipose tissue. A more specific term, lipoatrophy is used when describing the loss of fat from one area...

, which simply refers to fat loss.

Symptoms

The most common manifestations of body fat redistribution are accumulations of fat in the central body in the form of a fat pad on the back of the neck and an accumulation of visceral fat in the abdomen or belly. This fat accumulation is accompanied by a loss of subcutaneous fat in the face, arms, legs, and buttocks.

Adverse effects

Cosmetic concerns may cause patients to refuse or stop treatment. If severe enough, the fat accumulation may result in sleep apnea

Sleep apnea

Sleep apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from a few seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low...

 or other sleep disorders, migraines, decreased range of motion, discomfort due to pressure on internal organs, and general loss of condition. Fat loss may result in pain in the buttocks when seated. Other potential complications resulting from BFR include high cholesterol, high levels of triglycerides, insulin

Insulin

Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....

 resistance, hyperglycemia

Hyperglycemia

Hyperglycemia or Hyperglycæmia, or high blood sugar, is a condition in which an excessive amount of glucose circulates in the blood plasma. This is generally a glucose level higher than 13.5mmol/l , but symptoms may not start to become noticeable until even higher values such as 15-20 mmol/l...

, diabetes, gout

Gout

Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...

, and cardiovascular disease

Cardiovascular disease

Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...

. BFR is also associated with certain metabolic abnormalities such as elevations of plasma sugar and fats, but the precise relationship is unknown.

Treatment

Treatment of symptoms may include cosmetic surgery such as collagen implants; treatment of the underlying syndrome may include changing from protease inhibitors to an NNRTI.