Factors Associated with Severe Impact of Lipodystrophy on the Quality of Life of HIV Patients

Now HIV-1 infection is considered to be a chronic illness, quality of life (QoL) has become an important outcome measurement. Few instruments specifically measure QoL in HIV-1–infected patients, and none are specific for lipodystrophy (LD) in such patients.

HAART can produce side effects that may impair QoL and threaten compliance; in spite of this, <3% of drug trial publications incorporate measurement of QoL as an outcome variable. Instruments that assess body image should be developed to measure QoL in HIV-1–infected patients, and more attention should be paid to specific dimensions of QoL in the management of HIV-1--infected patients.

Conducted by Spanish researchers, the current study used a standardized questionnaire to assess the impact of lipodystrophy (LD) on quality of life (QoL).

Eighty-four consecutive asymptomatic human immunodeficiency virus type 1 (HIV-1)–infected outpatients with clinical LD completed a modified version of the Dermatology Life Quality Index (DLQI) survey to measure the impact of body fat changes on their QoL.

Body changes influenced dressing for 55 patients (65%), produced feelings of shame for 41 (49%), and disrupted sexual life for 23 (27%).

There was a greater impact on the DLQI due to body changes among women, injection drug users, patients with abdominal or breast lipoaccumulation, and patients with a high number of non-LD side effects.

Multivariate proportional odds model analysis showed that the severity of non–LD-associated side effects and the presence of breast lipoaccumulation were associated with impaired psychosocial functioning.

The authors conclude, “Specific characteristics of patients, antiretroviral-based side effects, and breast lipoaccumulation exert a greater impact on QoL in HIV-1-infected patients with LD.”

Discussion

Few studies of the impact of LD on QoL have used standardized questionnaires. One study collected data through a survey of participants in an Internet news group involving a discussion of experiences with LD. The most frequently reported psychological and social effects of LD were erosion of body image and self-esteem, problems in social and sexual relationships, loss of locus of control, anxiety related to disclosure issues, and propensity toward demoralization and depression.

Although in a previous study the investigators found no differences in overall QoL between patients with and patients without LD, they noted that some patient characteristics were associated with a greater impact on QoL.

Among men who have sex with men, unemployed patients, and patients currently undergoing psychiatric treatment, the decrease in some of the QoL subscale scores associated with psychological well-being was greater for those with LD than for those without LD. We concluded that these groups of patients seem to be more vulnerable to the psychological impact of LD on QoL.

In the present study, results of multivariate analysis indicate that the risk of problems associated with social and spare-time activities is nearly 6 times greater for patients with lipodystrophic changes in the breast area than for patients without these changes and that patients with lipodystrophic changes in the face are 3 times more likely to try to find solutions to their body changes than are patients without facial changes.

05/05/04

Reference
J Blanch and others. Factors Associated with Severe Impact of Lipodystrophy on the Quality of Life of Patients Infected with HIV-1. Clinical Infectious Diseases 38(10): 1469-1475. May 15, 2004.