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1st International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV26–28 June 1999 - San Diego, CA, USA |
DESCRIPTION OF LIPODYSTROPHY IN THE HIV OUTPATIENT STUDY (HOPS)
Antiviral Therapy 1999; 4(Suppl. 2):39 (abstract no. 14)
DJ Ward1, KM Delaney2, AC Moorman3, K Lichtenstein4, F Palella5, B Young4, KC Wood6, SD Holmberg3 and the HOPS Investigators
1Dupont Clinical Practice Group, Washington, DC; 2Chicago, Illinois; 3Centers for Disease Control and Prevention, Atlanta, Georgia; 4Rose Medical Group/University of Colorado Health Sciences Center, Denver, Colorado; 5Northwestern University Medical School, Chicago, Illinois; and 6APACHE Medical Systems, McLean, Virginia, USA
BACKGROUND: To describe manifestations of lipodystrophy among patients in the HOPS, clinicians interviewed and assessed signs of fat redistribution in a survey among 89% (1077) of patients visiting 8 clinics in 7 US cities from 10/98-12/98. Medical record data on impairment of glucose control and blood lipid values were included for analysis.
RESULTS: We devised a classification system based on the distribution of severity of physical findings and number/location of affected body areas. Of all respondents, 548 (51%) had no physical manifestations (level A); 325 (30%) had 1-2 mild/moderate signs including central adiposity, fat loss in extremities or hips/buttocks (level B, mild); 138 (13 %) had 3-4 mild/moderate signs including facial changes (level C, moderate); and 66 (6%) had 5-6 signs, some severe, including dorsocervical fat pad (level D, severe). Impaired glucose control was reported for 5% in A, 6% in B, 9% in C, and 17% in D. Median blood lipid values (fasting status unknown) increased relative to the level of clinical symptoms (chi-square P<0.05 for all trends): for cholesterol in A, 192; B, 203; C, 206; D, 212; risk ratio (total cholesterol/HDL) in A, 4.7; B, 6.1; C, 5.8; D, 6.4; and triglycerides in A, 186.5; B, 236; C, 260.5; D, 321.
CONCLUSIONS: We characterized physical manifestations of lipodystrophy in a large cohort of HIV-infected individuals and propose a stratified case definition that corresponded well with laboratory evidence of elevation in blood lipids.
These limitations have been overcome with case-finding survey tools with sufficient sensitivity to screen individuals for further evaluation. SLE was the first disease so studied; Reiter's and the connective tissue diseases as a group have also case-finding techniques developed. Most of them are indeed based on self-reported versions of the ACR criteria.
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