Impact of Lipodystrophy on the Quality of Life of HIV-1-Infected Patients
February 11, 2003
Body changes due to lipodystrophy present an important problem for HIV-1-infected patients on HAART. Body changes can erode self-image and self-esteem, stigmatize patients, cause problems in social and sexual relations and lead to depression and anxiety. Many patients adjust to the limitations of lipodystrophy in the interest of survival. Some, however, lose interest in complying with complex drug regimens, which eventually leads them to discontinue control of their HIV infection.Adapted from:
The authors assessed the impact of lipodystrophy on quality of life (QoL) in 150 HIV patients, using standardized questionnaires. Eligible patients were clinically stable, had received more than one year of HAART, and could understand questionnaires. Patients answered questions about age, sexual orientation, partnership, social class, employment, psychiatric history and self-evaluation of their psychological and physical status on an ordinal scale. Researchers obtained HIV-1-related data from medical files, and they assessed ART compliance by asking the patients about their last week of treatment. Investigators queried participants about the presence of the most prevalent adverse effects of antiretroviral drugs.
Eighty-four patients (56 percent) had clinical criteria for lipodystrophy. Those with lipodystrophy were older and had been on antiretroviral therapy longer than those without the condition. Data analysis showed that lipodystrophy itself was not an overall influence on quality of life as measured by a Spanish adaptation of the Profil der Lebensqualität Chronischkranker (PLC). However, after researchers stratified the patients in categories, data analysis revealed significant differences on some of the PLC subscales. Patients with lipodystrophy who were homosexual, unemployed and currently undergoing psychiatric treatment showed greater impairment on some quality of life subscales related to physiological well-being.
The authors found that homosexual men seemed to be more vulnerable to the psychological impact of lipodystrophy on quality of life than heterosexual patients. They also found that taking psychiatric treatment such as methadone, tranquilizers or antidepressants was associated with a greater impact of lipodystrophy on quality of life. Previous studies, they noted, showed that psychiatric disorders tend to have an increased impact on QoL in HIV-1-infected patients in general. "However," they cautioned, "in our study we could not determine whether patients from our sample were anxious or depressed as a result of lipodystrophic changes."
"Additional studies increasing the power of the analysis by using a greater number of patients should be performed to deepen our understanding of the impact of lipodystrophy on QoL, to improve our ability to measure this impact, and to design strategies to improve or preserve QoL in HIV-infected patients," the authors concluded. "Special attention should be paid to vulnerable subgroups such as homosexual men and patients with psychiatric disorders."
Journal of Acquired Immune Deficiency Syndromes
12.01.02; Vol. 31: P. 404-407; Jordi Blanch; Araceli Rousaud; Esteban Martínez; Elisa De Lazzari; Josep-Maria Peri; Ana Milinkovic; Jose-Bernardo Perez-Cuevas; José Luís Blanco; Josep-Maria Gatell
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.