Lipodystrophy in a Cohort of Human Immunodeficiency Virus–Infected Asian Patients: Prevalence, Associated Factors, and Psychological Impact

Abstract

We investigated the prevalence of and factors associated with lipodystrophy in a cohort of human immunodeficiency virus (HIV)-infected patients in Singapore. A standardized questionnaire was administered to 410 consecutive patients (mainly Chinese men), and blood samples were obtained for metabolic measurements for fasting patients. Peripheral fat loss was reported by 46% of subjects, central fat gain was reported by 32%, and 8% of patients overall had a mixed clinical presentation. Levels of total cholesterol, triglycerides, glucose, and lactate were elevated in 19%, 38%, 12%, and 16% of patients, respectively. A mixture of drug-related and non-drug-related factors was associated with these changes. The body-shape changes affected the mood of 36% of patients and the work and/or social activity of 23% of patients, but only <1% of affected subjects reported a desire to stop receipt of antiretroviral therapy because of these changes. We conclude that the prevalence of and factors associated with body-shape changes and metabolic abnormalities in HIV-infected Asian patients are similar to those reported for Western cohorts, but the changes did not appear to have a major psychosocial impact on this patient population.

Prevalence of and Clinical Factors Associated with Lipoatrophy in HIV-Infected Koreans Receiving Highly Active Antiretroviral Therapy

“…This study revealed that the prevalence of lipoatrophy in HIV-infected Koreans receiving HAART is not uncommon and was within the range of that reported in other studies (Lichtenstein et al 2001;Paton et al 2002;Bacchetti et al 2005;Jacobson et al 2005;Pujari et al 2005;Waters and Nelson 2007). The previous studies performed in single institute of Asia including South Korea, Singapore, India and Thailand reported the percentage of HIV-infected patients with peripheral fat loss as very wide range from 3.5% to 62.5% (Chang et al 2002;Paton et al 2002;Pujari et al 2005;Chuapai et al 2007).…”

Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects

“…Investigations that analyzed the onset of lipodystrophy according to the symptoms, observed an increase in abdominal girth in 32 to 60% of individuals, breast enlargement in 20%, facial lipoatrophy in 58%, loss of peripheral fat in 33 to 50%, and mixed manifestations in 8 to 86 % of patients (9,(14)(15) . According to the literature surveyed, the pathogeny of lipodystrophy continues to be largely unknown, although several risk factors for its occurrence have been described, including long-term HIV infection, prolonged use of protease inhibitors (14) and a CD4 count below 200 cells/mL (11) .…”

“…These included dissatisfaction with body image (5)(6) , mood alterations demonstrated by anxiety and unhappiness (15) , problems in sexual relations (5) , reduction in self-esteem, and depression (5)(6) .…”

“…The "contamination" of body image currently associated with lipodystrophy has been documented; however, the mechanisms underlying the visible disfiguring and stigmatizing morphological changes are still unknown (10,15,17) . In addition, BLANCH and colleagues (9) found that decreased sexual enjoyment and activity were observed after the development of lipodystrophy; however, there were no change in the frequency of condom use.…”

“…Patients also felt less physically well and were less confident in their relationships during their experience of lipodystrophy (9) . Regarding compliance to antiretroviral therapy, one study found that some patients intended to interrupt or abandon treatment as a result of body changes (15) . According to the literature, preoccupation and anxiety about the future and the possibility of occurrence of lipodystrophy, with its metabolic and morphologic complications, are frequent.…”