Sixth International Congress Drug Therapy in HIV Infection 17-21 November, 2002 Glasgow, UK

Background: Lipodystrophy (LD; peripheral lipoatrophy, central fat accumulation, and lipomatosis) is a common, disfiguring but ill-defined problem in HIV-infected patients receiving antiretroviral therapy that is associated with sub-optimal antiretroviral adherence. An objective, validated case definition of HIV LD was developed to improve assessments of LD prevalence and incidence (across and within various patient populations), potential risk factors (particularly antiretrovirals), pathogenesis, prevention and treatment.

Methods: The study was conducted at 32 hospital outpatient and primary care clinics in the Americas, Europe and Australasia. 1081 (79%; 15% female) patients were recruited consecutively, with equal numbers of cases and controls at each site, including 417 subjectively identified cases and 371 subjectively identified controls. Cases (¡Ý 1 moderate or severe LD feature) and unaffected controls, identified by the current subjective standard of concordant physician and patient assessments, were compared cross-sectionally using objective clinical, metabolic and body composition (DEXA and abdominal CT) parameters, all measured locally. Potential models were generated from randomly selected cases and controls by logistic regression of objective parameters (excepting treatments) significantly different between cases and controls. Models were validated in the remaining cases and controls. Scans were reanalysed locally to determine if this would change or simplify the final LDCD model or improve its sensitivity and specificity.

Results: A model comprising age, gender, HIV duration, HIV disease stage, waist:hip ratio, anion gap, high-density lipoprotein cholesterol, trunk:peripheral fat ratio and leg fat percent (on DEXA), and visceral:subcutaneous abdominal fat (VAT:SAT) ratio by CT (L4 level), had sensitivity of 79% (95% CI, 70 to 85%) and specificity of 80% (95% CI, 71 to 87%) for diagnosis of lipodystrophy. An LD scoring system was developed from the model (a score greater than zero defining LD). Simpler models incorporating only clinical, or only clinical and metabolic, parameters had lower sensitivity and specificity. Models for lipoatrophy, fat accumulation and lipomatosis could not be developed, as these pure phenotypes were found in no more than 9% of cases. Central DEXA and CT analysis did not substantially simplify the model, nor significantly alter its sensitivity or specificity.

Conclusion: This objective case definition and scoring system of HIVassociated LD, incorporating clinical, metabolic and body composition parameters, should improve the assessment of lipodystrophy prevalence, severity, risk factors, pathogenesis, prevention and treatment, and assist in diagnosis. The model will be available upon publication at http://www.med.unsw.edu.au/nchecr.

Presenting author: Andrew Carr

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1 On behalf of the HIV Lipodystrophy Case Definition Study Group, St Vincent’s Hospital, Sydney, Australia.

2002-11-17
PL9-3

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