Abstract
BackgroundLipodystrophy (LD) is a frequent adverse event of combination antiretroviral therapy (ART) and occurs mainly in patients exposed to first-generation antiretroviral drugs. The aim of this study was to explore and measure the interaction between LD, mental health, and quality of life of human immunodeficiency virus (HIV) positive individuals seen in a metabolic clinic.MethodsWe conducted a single-site cross-sectional study including all HIV-infected patients attending the LIPO group and metabolism day clinic at the University Hospitals of Geneva, Switzerland between January 31, 2008 and November 28, 2013. Data on LD were prospectively collected using the HIV Outpatient Study (HOPS) score, the Lipodystrophy Case Definition (LDCD), ART regimens, anthropometric measures, imaging, and standardized questionnaires. Quality of life was evaluated using a visual analog scale of 0–100. Depression and anxiety were assessed using the Beck Depression Inventory and the State Trait Anxiety Inventory scales, respectively.ResultsOne hundred ninety-four patients (54.6% male; 45.4% female; median age, 50 years) on successful ART (median CD4 cell count, 569.0 cells/mm3; median viral load, 20 copies/mL) were evaluated. Among these, 62.7, 63.5 and 35.5% of patients reported at least one body site affected by fat hypertrophy, atrophy or both, respectively. Using the LDCD score conservative definition, including imaging and biological values, 57.8% were diagnosed with LD. Of these, 39.7% suffered from severe/very severe LD. Depression was reported by 35.6% of individuals; 51.9% had anxiety symptoms and 49.5% reported poor quality of life (defined as being inferior to 50% on a scale from 0 to 100%). LD (odds ratio (OR = 5.22, 95% confidence interval (CI) 1.07–25.37, p-value: 0.040), depression (OR = 4.67, 95% CI 1.08–20.31, p-value 0.040), and anxiety (OR = 7.83, 95% CI 1.91–32.03, p-value 0.004) all affected significantly the quality of life.ConclusionsLD, depression and anxiety were frequent features among HIV-infected individuals seen in the metabolic clinic and significantly impacted on their quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12981-015-0061-z) contains supplementary material, which is available to authorized users.
Highlights
Lipodystrophy (LD) is a frequent adverse event of combination antiretroviral therapy (ART) and occurs mainly in patients exposed to first-generation antiretroviral drugs
Potential confounding risk factors of quality of life, such as depression and anxiety, we developed an additional model including clinical risk factors considered to have a potential impact on quality of life in human immunodeficiency virus (HIV) population: age; gender; severe LD (LDCD), atrophy and hypertrophy observed by patients and physicians (HOPS); body mass index (≥30 kg/m2); HIV duration (≥10 years); United States Centers for Disease Control and Prevention HIV stage (B&C); CD4 count (≤300 cells/mm3); and HIV viral load (≥40 copy/mL)
Results of our study indicate a high frequency of LD and mental health disorders among HIV-infected men and women on successful ART presenting at the LIPO group and metabolism day clinic
Summary
Lipodystrophy (LD) is a frequent adverse event of combination antiretroviral therapy (ART) and occurs mainly in patients exposed to first-generation antiretroviral drugs. Diagnosis is based mainly on clinical observations by the patients themselves and by the physicians To help meeting this challenge, the HIV Outpatients Study (HOPS) scale provides a subjective, but standardized LD evaluation using specific questions related to the clinical signs of the disorder [8]. Carr et al developed a score in order to offer a more objective definition of LD, the Lipodystrophy Case Definition (LDCD), with a reported 79% sensitivity and 80% specificity [9, 10]. This score does not allow differentiating between disease phenotypes [6]
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