Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
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ORIGINAL ARTICLE
Year : 2008  |  Volume : 29  |  Issue : 2  |  Page : 86-88
 

Lipodystrophy among AIDS patients: A preliminary report


1 Madurai Medical College and Government Rajaji Hospital, Madurai - 625 020, India
2 Emeritus Professor of Internal Medicine The Tamilnadu Dr. MGR Medical University, Chennai, India

Correspondence Address:
M Srinivasan
136, Second East Main Road, Anna Nagar, Madurai - 625 020, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7184.48731

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   Abstract 

Background : Lipodystrophy (LD) is potentially stigmatizing and contributes to poor adherence to ­antiretroviral therapy. Objectives : To find out the prevalence and pattern of LD among Acquired Immune Deficiency ­ Syndrome (AIDS) patients receiving Highly Active Antiretroviral Therapy (HAART), and to assess the ­psychological distress related to LD. Materials and methods : A cross-sectional study was designed after institutional ethical clearance and informed consent from 50 AIDS patients on HAART. Data collected were physical examination and response to a standardized questionnaire (Assessment of Body Changes and Distress questionnaire). They were analyzed using SPSS 14.0. Results : All subjects were on lamivudine, stavudine, and nevirapine (82%) or efavirenz (18%). The prevalence of LD was 28% (M = 5; F = 9) and ­significantly more among women ( P = 0.019). The pattern of LD perceived by patients and assessed on physical examination were abdominal obesity in 50 and 38%, breast hypertrophy in 28 and 14%, wasting of buttocks in 22 and 26%, lipoatrophy of arms in 24 and 28%, and wasting of facial muscles in 20 and 32%, respectively. The overall perceived changes were 68%, while assessed were 62%. The body changes caused significant psychological distress to the patients ( P = 0.001), although compliance was good. Conclusion : The study calls for early detection of LD and treatment or provision of alternative medicines and counseling of these patients, to reduce the physical and psychological burden.


Keywords: Body changes, compliance, gender, HAART, lipoatrophy, lipohypertrophy, pattern, prevalence, psychological stress


How to cite this article:
Srinivasan M, Parthasarathy M R, Vinodhkumaradithyaa A, Ananthalakshmi I, Thirumalaikolundusubramanian P. Lipodystrophy among AIDS patients: A preliminary report. Indian J Sex Transm Dis 2008;29:86-8

How to cite this URL:
Srinivasan M, Parthasarathy M R, Vinodhkumaradithyaa A, Ananthalakshmi I, Thirumalaikolundusubramanian P. Lipodystrophy among AIDS patients: A preliminary report. Indian J Sex Transm Dis [serial online] 2008 [cited 2019 Nov 22];29:86-8. Available from: http://www.ijstd.org/text.asp?2008/29/2/86/48731



   Introduction Top


Lipodystrophy has been reported as one of the major side effects of antiretroviral therapy. Lipodystrophy (LD) is characterized by fat loss (lipoatrophy) in the face, arms, buttocks, and legs; or/and fat gain (lipohypertrophy) in the abdomen and breasts, as well as over the back of the neck ("buffalo hump"); and occasionally isolated lipomata elsewhere. The morphological changes are potentially stigmatizing resulting in poor adherence to antiretroviral therapy and hence treatment failure. So it was proposed to find out the prevalence and pattern of LD among AIDS patients receiving Highly Active Antiretroviral Therapy (HAART) and to assess the psychological distress related to LD.


   Material and method Top


This was a cross-sectional study carried out among 50 AIDS patients (32 males, 18 females) attending the Anti-Retroviral Therapy (ART) Centre of the Government Rajaji Hospital, Madurai, Tamilnadu, India, after institutional ethical clearance and with an informed consent of the participants.

The eligible patients were above 20 years without active opportunistic infection and on antiretroviral therapy, defined as two Nucleotide Reverse Transcriptase Inhibitors (NRTIs-lamivudine and stavudine) and one Non-Nucleotide Reverse Transcriptase Inhibitor (NNRTI-Nevirapine 82% and Efavirenz 18%) for at least six months, as per National AIDS Control Organization (NACO). The patients were excluded if they were unable to read the questionnaire and respond on their own or had dementia or disorientation.

Epidemiological, clinical, and socio-demographic characteristics of the enrolled patients, including the number of months on ART were collected. Lipodystrophy was considered as moderate or severe peripheral wasting (thinning of arms, legs or buttocks) or central fat accumulation (increase in abdomen or breast) as reported by the physical examination. Body mass-index (BMI) and waist-to-hip ratio were measured.

They were provided with a validated questionnaire called the Assessment of Body Changes and Distress (ABCD) questionnaire, [1] in Tamil, comprising of 27 items, divided into three parts, in order to explore the impact of LD on everyday habits, adherence to antiretroviral therapies, and relationships. The questionnaire took about five minutes to complete. The first six items were yes/no questions pertaining to specific signs of LD, intended to discriminate patients with and without LD. Patients who gave at least one positive answer proceeded to fill out the questionnaire. Question #7 was about satisfaction with one's body appearance. Response options were on a five-point Likert-type scale ranging from 1 (best satisfaction) to 5 (poorest satisfaction). The third part of the questionnaire included 20 questions (8a to 8v) about the psychosocial consequences of body changes in the last 4 weeks. Responses were on a five-point Likert-type scale ranging from 1 (greatest adverse impact of LD) to 5 (no impact). Responses to the 20 items were scored as a summated rating scale.

For this analysis, the scores for question 7 and question 8 summary score were used. Analysis was done using SPSS 14.0 for Windows XP.


   Result Top


Of the 50 patients screened, 14 (M = 5; F = 9) met the study definition for lipodystrophy (LD+). Hence the prevalence of LD was 28%. The 36 who did not have LD (LD-), were kept as the control group. The pattern of LD perceived by patients and assessed on physical examination were abdominal obesity in 25 and 19, breast hypertrophy in 14 (4 females) and 4 (3 females), wasting of buttocks in 11 and 13, lipoatrophy of arms in 12 and 14, and wasting of facial muscles in 10 and 16, respectively. The demographic variables along with clinical data and the results of the questionnaire are furnished in [Table 1] and [Table 2], respectively.


   Discussion Top


The prevalence of LD was 28% (n = 14), probably related to stavudine, as stavudine has been particularly implicated in the apoptosis of adipocytes. [2] In contrast to the present observation, LD was observed in 53-55% as reported earlier. [3,4] This variation could probably be attributed to the noninclusion of protease inhibitors in our treatment regimen. The most common cause of HIV-associated lipodystrophy is HAART, particularly with HIV-1 protease inhibitors.

Abdominal obesity and breast hypertrophy were reported more by patients, while wasting of buttocks, facial muscles, and arms were revealed more on physical examination. This could be explained by the changes in shirt/blouse and waist size caused by central lipohypertrophy causing concern to the patient while wasting of buttocks and limbs is usually overlooked as these areas are not noticed much.

Lipodystrophy was found to be significantly more in females ( P = 0.019). The questionnaire survey revealed the patients with lipodystrophy were significantly less satisfied with their body looks ( P < 0.001) and had significant psychological stress ( P = 0.001) compared to the LD- (LD negative) refers to the group which does not have Lipodystrophy. Despite LD, these patients continued their medications regularly.

The physical examination was done by the first two authors themselves and the third author was consulted in case of discrepancies and the decision of any two was regarded final, thus making the observations reliable. However, further studies with a larger study group are recommended. Limitations are due to recall bias and the socio cultural concepts among the participants.

The study calls for early detection of LD and treatment of lipodystrophy associated with HAART or provision of alternative antiretroviral drugs and counseling of the patients, to reduce the physical and psychological burden. Also, the role of growth hormone testosterone derivatives like nandrolone and oxandrolone, and anti-lipemic drugs in the prevention of LD, need to be assessed.

 
   References Top

1.Guaraldi G, Murri R, Orlando G, Giovanardi C, Squillace N, Vandelli M, et al . Quality of life and body image in the assessment of psychological impact of lipodystrophy: Validation of the Italian version of Assessment of Body Change and Distress questionnaire. Quality of Life Research 2006;15:173-8.  Back to cited text no. 1    
2.Cherry CL, Lal L, Thompson KA, McLean CA, Ross LL, Hernandez J, et al . Increased adipocyte apoptosis in lipoatrophy improves within 48 weeks of switching patient therapy from Stavudine to abacavir or zidovudine. J Acquir Immune Defic Syndr 2005;38:263-7.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Miller J, Carr A, Emery S, Law M, Mallal S, Baker D, et al . HIV lipodystrophy: Prevalence, severity and correlates of risk in Australia. HIV Med 2003;4:293-301.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Diehl LA, Dias JR, Paes AC, Thomazini MC, Garcia LR, Cinagawa E, et al . Prevalence of HIV-associated lipodystrophy in Brazilian outpatients: Relation with metabolic syndrome and cardiovascular risk factors. Arq Bras Endocrinol Metabol 2008;52:658-67.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]



 
 
    Tables

  [Table 1], [Table 2]



 

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    Abstract
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    Material and method
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