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. 2014 Aug 4:11:26.
doi: 10.1186/1742-6405-11-26. eCollection 2014.

The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings

Zulfa Abrahams  1 , Joel A Dave  1 , Gary Maartens  2 , Maia Lesosky  3 , Naomi S Levitt  1
Affiliations

The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings

Zulfa Abrahams et al. AIDS Res Ther. .

Abstract

Background: Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definitions have been developed to diagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less visceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple, objective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and dual-energy X-ray absorptiometry (DXA) -derived variables.

Methods: DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South African men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected using a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance of anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference standard.

Results: Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men (10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best predictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC =0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb fat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip ratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647).

Conclusions: We were able to develop simple, anthropometric measures for defining lipoatrophy and lipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing patients with lipoatrophy and lipohypertrophy.

Keywords: Anthropometry; Antiretroviral therapy; DXA; HIV; Lipoatrophy; Lipodystrophy; Lipohypertrophy; Sub-Saharan africa.

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Figures

Figure 1
Figure 1
ROC curves for the 2 anthropometric and DXA-derived variables with the highest AUC for lipoatrophy and lipohypertrophy in female participants on ART.
Figure 2
Figure 2
Lipoatrophy variables for female participants on ART with ROC AUCs of ≥0.6 and their 95% confidence intervals in descending order of AUC.
See this image and copyright information in PMC

References

    1. Johnson LF. Access to antiretroviral treatment in South Africa, 2004-2011. SA J HIV Med. 2012;13(1):22–27.
    1. Schambelan M, Benson CA, Carr A, Currier JS, Dubé MP, Gerber JG, Grinspoon SK, Grunfeld C, Kotler DP, Mulligan K. Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: recommendations of an International AIDS Society-USA panel. J Acquir Immune Defic Syndr. 2002;31(3):257–275. - PubMed
    1. Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med. 2005;352(1):48–62. - PubMed
    1. Carr A. HIV protease inhibitor-induced lipodystrophy syndrome. AIDS Rev. 1999;1:29–36.
    1. Carter V, Hoy J, Bailey M, Colman P, Nyulasi I, Mijch A. The prevalence of lipodystrophy in an ambulant HIV‒infected population: it all depends on the definition. HIV Med. 2001;2(3):174–180. - PubMed

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