The Australian Prevalence Survey of Lipodystrophy Syndrome
J. E. MILLER*, S. EMERY, M. FRENCH, D. BAKER, D. A. COOPER, and the Australian Lipodystrophy Syndrome Res. Group.
NCHECR, UNSW, Sydney, Australia
Objectives: To establish the prevalence of lipodystrophy syndrome (LD) defined by clinical features and laboratory profiles, a cross-sectional survey was conducted through a national network of investigator sites.
Methods: Participating sites represented high HIV case load primary care sites and HIV Units in major teaching hospitals in Australia. Consenting HIV +ve patients had the following data collected; demography, CD4+ and CD8+ cell counts, HIV viral load, antiretroviral (ARV)history, subjective assessment of LD sites and severity (standardised questionnaire and physical examination), metabolic measures (lipids, glucose, insulin and hepatic enzymes), waist and hip circumference and skin-fold thickness tests. A subset of patients were examined using DEXA scans and single cut CT (L4) to determine both regional and total body fat levels.
Results:1350 patients (97% male, 3% female) were surveyed between November 1998 and June 1999. 52% were asymptomatic and 20% had AIDS. Mean CD4+ count was 486 cells/mm3 and 55% patients had an HIV RNA level below 500 copies/ml at the time of reporting. 15%participants had never received a protease inhibitor (PI) and 63% were receiving at least one PI. Physician assessed prevalence of body habitus changes in the survey was 51% and of these, 55% reported both central fat accumulation and peripheral lipo-atrophy, 31% reported peripheral lipo-atrophy only, 14% reported central fat accumulation only. Prevalence of patient assessed body habitus change was 57%. Concordance between physician and patient assessment was 88%. Prevalence of body habitus changes consistent with LD was 81% in PI-experienced patients, 33% in PI-naive patients and 5% in ARV naive patients. Number of sites affected and severity was higher in the PI treated group. Frequently reported, physician assessed body shape changes were; buttock wasting (74%), central obesity (70%), prominent veins (70%), lipo-atrophy of the arms (70%) legs (67%) and face (65%). Dorsocervical fat pad enlargement was noted in 3% of patients.
Conclusions: This survey confirms and expands upon earlier reports of LD in terms of prevalence and clinical features. The prevalence and severity of LD reflects both length and type of treatment with ARV therapy.
Key Words: antiretroviral, lipoatrophy, lipodystrophy