Background: Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly\nassociated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only\nrecently been phased out and AZT is still widely being used. Several case definitions have been developed to\ndiagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less\nvisceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple,\nobjective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and\ndual-energy X-ray absorptiometry (DXA) -derived variables.\nMethods: DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South\nAfrican men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected\nusing a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance\nof anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference\nstandard.\nResults: Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men\n(10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best\npredictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC\n=0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb\nfat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip\nratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647).\nConclusions: We were able to develop simple, anthropometric measures for defining lipoatrophy and\nlipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular\nrelevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing\npatients with lipoatrophy and lipohypertrophy.
Loading....