9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 19-21 July 2007, Sydney, Australia

VALIDATION OF A SIMPLE CLASSIFICATION FOR FACIAL LIPOATROPHY IN HIV-INFECTED ADULTS

Antiviral Therapy 2007; 12(Suppl. 2):L31 (abstract no. P-18)

J Fontdevila¹, J Berenguer², E Prades³, T Pujol², E Guisantes¹, JM Serra-Renom¹, J Gatell⁴ and E Martínez^4
1Plastic Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain; ²Center for the Diagnosis by the Image, Hospital Clínic, University of Barcelona, Spain; ³Statistic evaluator, Hospital Clínic, University of Barcelona, Spain; ⁴Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain

OBJECTIVES: We have previously developed an anatomical- based classification for facial lipoatrophy including four potential degrees: ‘zero’ (convexity of malar skin from the orbita to the nasolabial fold), ‘one’ (flattening of malar protrusion), ‘two’ (skin sinking under the malar bone), and ‘three’ (all above with showing of zygomatic major muscle). We aimed to validate this classification assessing its reproducibility among different clinicians and its correlation with the objective amount of cheek fat for different degrees of facial lipoatrophy.

METHODS: After being instructed, randomly chosen clinicians from the HIV and Plastic Surgery Units independently scored front and lateral facial photographs from non-HIV- and HIV-infected adults. In patients with at least degree ‘one’ of facial lipoatrophy the volume of fat comprised in a delimited area of the cheeks (in height, 9 mm down from nasal anterior spine, in depth from skin to bone, and in width from masseteric anterior rim to the nasolabial fold), was assessed using a volumetric measurement by computed tomography (CT) with the software VOLUME® (Siemens AG). Reproducibility was assessed with the kappa coefficient and comparisons of fat volume among different degrees of facial lipoatrophy were done with ANOVA test.

RESULTS: Nine clinicians (five HIV physicians, four plastic surgeons) scored photographs from 101 adults. The global level of concordance was 0.68 (P<0.001). Concordance levels for degrees ‘zero’, ‘one’, ‘two’ and ‘three’ were 0.89, 0.59, 0.54 and 0.73, respectively (P<0.0001 each). Forty- four patients classified with degrees ‘one’ (n=7), ‘two’ (n=25), and ‘three’ (n=12) underwent a CT scan of the face. The mean and 95% confidence interval 95% CI of cheek fat in patients with degrees ‘one’, ‘two’ and ‘three’ was 4.4 cm³ (95% CI: 3.0 to 5.8), 3.0 cm³ (95% CI: 2.3 to 3.7), and 1.7 cm³ (95% CI: 0.9 to 2.6), respectively (P<0.005 each).

CONCLUSIONS: This simple and easy-to-use clinical classification showed good reproducibility among different investigators and discriminated against the amount of cheek fat in HIV-infected adults with facial lipoatrophy. In the absence of simple and accurate methods to measure the degree of facial lipoatrophy, this classification may be useful for clinical and research purposes.

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2007-07-24
P-18

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