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HIV lipodystrophy case definition: full details published
A lipodystrophy case definition developed by a working party convened by the European Medicines Evaluation Agency has been published in the March 1 edition of The Lancet.
The group, led by Dr Andrew Carr of Sydney’s St Vincent’s Hospital, conducted an international case control study in which 1081 consecutive HIV-positive individuals without active opportunistic infections were assessed by clinicians to identify 417 cases in which lipodystrophic changes were clearly evident to both doctor and patient, and 317 controls without lipodystrophic changes.
Objective measures of HIV disease-related parameters, fat distribution, lipids, glucose and blood chemistry were recorded, together with physical symptoms such as dry skin, reduced libido, blood pressure, and behaviours such as alcohol consumption and physical activity. The variables were then submitted to multivariate logistic regression analysis to identify significant associations.
The final model, with a specificity of 79% (95 CI 70-85) and a sensitivity of 80% (CI 71-87), contained ten variables (see table below). Models with fewer variables, omitting body composition measurements using DEXA or CAT only, or body composition and laboratory measurements, proved less sensitive and specific. Nevertheless, the study website offers details of the minimal definition that may prove useful to the clinician without the resources to carry out body composition measures.
A major controversy concerning the definition is its lack of agreement with the FRAM study, which found that lipoatrophy was the only body composition feature that differed between HIV-positive men and age-matched HIV-negative controls. The authors say that even when they excluded patients who only exhibited fat accumulation without lipoatrophy, the final model still contained the same variables. A separate case definition for lipoatrophy was impossible to develop because too few patients had lipoatrophy alone.
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Full case
definition
Clinical and
laboratory data (but no body imaging data)
Clinical data
(but no body imaging or laboratory data)
Female gender
Age over 40 years
HIV duration > 4 years
CDC category C
Increased waist:hip ratio
Decreased HDL cholesterol
Increased anion gap
Increased ratio of visceral adipose tissue to subcutaneous adipose
tissue
(>1.59)
Increased trunk to limb fat ratio
Decreased leg fat percentage (<8.8%)
Gender
Age
HIV Duration
CDC category
Waist:Hip ratio
Estimated LDL cholesterol
Triglycerides
Lactate
Anion gap
Age
HIV duration
CDC Category
CD4 change from nadir
waist circumference
Further information
Lipodystrophy Case Definition study website
Reference
HIV Lipodystrophy Case Definition Group. An objective case definition of Lipodystrophy in HIV-infected adults: a case-control study. The Lancet 361: 726-35, 2003.
The group, led by Dr Andrew Carr of Sydney’s St Vincent’s Hospital, conducted an international case control study in which 1081 consecutive HIV-positive individuals without active opportunistic infections were assessed by clinicians to identify 417 cases in which lipodystrophic changes were clearly evident to both doctor and patient, and 317 controls without lipodystrophic changes.
Objective measures of HIV disease-related parameters, fat distribution, lipids, glucose and blood chemistry were recorded, together with physical symptoms such as dry skin, reduced libido, blood pressure, and behaviours such as alcohol consumption and physical activity. The variables were then submitted to multivariate logistic regression analysis to identify significant associations.
The final model, with a specificity of 79% (95 CI 70-85) and a sensitivity of 80% (CI 71-87), contained ten variables (see table below). Models with fewer variables, omitting body composition measurements using DEXA or CAT only, or body composition and laboratory measurements, proved less sensitive and specific. Nevertheless, the study website offers details of the minimal definition that may prove useful to the clinician without the resources to carry out body composition measures.
A major controversy concerning the definition is its lack of agreement with the FRAM study, which found that lipoatrophy was the only body composition feature that differed between HIV-positive men and age-matched HIV-negative controls. The authors say that even when they excluded patients who only exhibited fat accumulation without lipoatrophy, the final model still contained the same variables. A separate case definition for lipoatrophy was impossible to develop because too few patients had lipoatrophy alone.
definition
laboratory data (but no body imaging data)
(but no body imaging or laboratory data)
Age over 40 years
HIV duration > 4 years
CDC category C
Increased waist:hip ratio
Decreased HDL cholesterol
Increased anion gap
Increased ratio of visceral adipose tissue to subcutaneous adipose
tissue
(>1.59)
Increased trunk to limb fat ratio
Decreased leg fat percentage (<8.8%)
Age
HIV Duration
CDC category
Waist:Hip ratio
Estimated LDL cholesterol
Triglycerides
Lactate
Anion gap
HIV duration
CDC Category
CD4 change from nadir
waist circumference
Further information
Lipodystrophy Case Definition study website
Reference
HIV Lipodystrophy Case Definition Group. An objective case definition of Lipodystrophy in HIV-infected adults: a case-control study. The Lancet 361: 726-35, 2003.