Pubic lipomas: a new manifestation of lipodystrophy?

Derek Thaczuk
Published: 16 May 2007

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.

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 < 0.0001 for both BMI and buffalo hump).

Logistic regression analysis identified the following risk factors: obesity (BMI > 30: β=0.18, p < 0.001), being female (β=1.06, p < 0.001), and having been HIV-infected a shorter period of time (β=-0.005, p = 0.04). The higher frequency in women is consistent with higher rates of fat accumulation in lipodystrophy among women; the researchers were not able to explain the association with shorter duration of infection.

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.”


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.

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