The majority of HIV-positive individuals with body fat changes caused by HAART said that lipodystrophy had a negative impact on their quality of life, according to a Spanish study published in the May 15th edition of Clinical Infectious Diseases, which is now available on-line. The investigators also found that the precise way lipodystrophy affected quality of life differed according to variables including the type of body fat change experienced, the presence of other HAART-related side-effects, HIV risk group, and gender.
A total of 150 patients in Barcelona who had been taking a stable HAART regimen for at least a year completed the quality of life questionnaire. The questionnaire was an adapted version of the one used to judge the effect of skin disorders on quality of life. The investigators reasoned that this questionnaire was particularly suitable, given the potential for both skin disorders and body fat changes to be stigmatising.
Body fat changes were reported by 84 patients, 72 of whom had changes in two or more body sites. Fat loss from the face (58%), thinning of the arms (50%), abdominal enlargement (60%), thinning of the legs (79%), and fat loss from the buttocks (73%) were the most commonly reported body shape changes.
Overall, the investigators found that 65% of individuals with lipodystrophy reported that the side-effect had altered the way they dressed. Feelings of shame caused by body fat changes were reported by 49% of patients, and 27% of individuals said that lipodystrophy disrupted their enjoyment of sex.
The investigators also found that the extent to which lipodystrophy damaged quality of life, and the type of disruption the side-effect caused, differed according to the gender and HIV risk group. Women were significantly more likely to report that body fat changes caused problems with day-to-day activities (p=0.036), with dressing (p=0.28) and with their sex lives (p=0.028) than were men. Drug users were significantly more likely to report that lipodystrophy negatively affected their ability to work (p=0.028) and engage in sporting activities (p=0.002) than were other groups.
Individuals with fat gain in the abdominal area were more likely to feel ashamed of their body shape (p=0.043) and have more problems dressing (p=0.049) than other patients, whereas patients with changes in breast shape had more sexual problems (p=0.011) than other patients.
Fat loss from the face was the condition most likely to prompt an individual to take action to address their lipodystrophy (p=0.12).
In univariate analysis, the investigators found that the length of time with HIV infection (p=0.14), the presence of other side-effects caused by HAART (p<0.001), injection drug use (p=0.048) and changes to the breast (p=0.003), face (p=0.041), and legs (p=0.039) were all significantly associated with impaired quality of life and psychosocial functioning. In multivariate analysis only severe side-effects other than lipodystrophy (p=0.008) and changes to the shape of the breasts (p=0.001) remained statistically significant.
The investigators recommend that medical, psychological and social interventions should be designed specifically for the sub-groups of patients whose quality of life is negatively affected by body fat changes caused by HAART.
Further information on this website
Lipodystrophy - overview
Lipodystrophy - factsheets
Mental health - factsheet
Blanch J et al. Factors associated with severe impact of lipodystrophy in the quality of life of patients infected with HIV-1. Clinical Infectious Diseases 38 (on-line edition), 2004.