Lipoatrophy (fat loss) in the face is a common occurrence among individuals with HIV treated with HAART. The change in facial appearance due to this condition may cause significant stress and a disruption of normal social functioning.

Data are scant regarding the effects of lipoatrophy on psychological and social functioning. The objectives of the current study were to evaluate quality of life, self esteem and mood in HIV patients with facial lipoatrophy and to explore psychosocial adjustment in individuals with HIV-related lipoatrophy.

The methodology employed to achieve these objectives was to have 35 patients attending a lipoatrophy service in a London teaching hospital complete the following questionnaires at initial assessment: Facial Appearance Questionnaire, Rosenberg Self Esteem Scale, Hospital Anxiety and Depression Scale (HADS) and MOS SF 36.

Results

34 of 35 participants were male and mean age was 44 years.
Twenty-five (71%) had case/borderline anxiety and 17 (48%) case/borderline depression on the HADS.
Self-esteem scores were low (mean=16.7 +/- 4) and correlated inversely with levels of anxiety (r=0.82).
Thirty-four participants (97%) felt lipoatrophy affected their confidence and 30 subjects (85%) felt stigmatized and that their appearance was a marker of HIV infection.
Participants had significant limitations in usual role activity and quality of life;
97% of participants felt that facial appearance affected their confidence, 85% of the respondents felt that their facial appearance was a marker of HIV and 25 (71%) had social anxiety related to their appearance.
Patients also reported concern both about the success of polylactic acid treatment for their lipoatrophy (17 [50%]) and the durability of treatment effect (12 [60%]).

Based on these results, the study authors conclude, “Patients attending a lipoatrophy clinic have high levels of anxiety and depression and quality of life and self esteem is lower than in other reports of chronic illnesses.”

“There is a high level of concern about enforced disclosure of HIV status due to the visible nature of facial lipoatrophy and stigma related to HIV.”

12/09/05

Reference
CA O’Donovan and others. Psychosocial adjustment to facial lipoatrophy in people with HIV. Abstract 34. 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV. November 13-16, 2005, Dublin, Ireland. Antiviral Therapy 2005; 10:L24.