October 22, 2002
LDS is an obstacle for successful therapy because of increasing morbidity and the possible necessity of switching the combination of antiretroviral compounds. Affected persons may complain about social problems because of the loss of their characteristic appearance. Reduction of facial fat is likely to carry the greatest stigma, one of the central problems in the lives of people with HIV/AIDS. The present study investigated attitudes toward health condition, well-being, and individual appearance in relation to LDS.
The case definition of LDS was as follows: lipoatrophy of the face was defined as loss of buccal fat and pronounced nasolabial fold; lipoatrophy of the extremities was defined as fat loss of arms and legs with prominent veins not caused by other venous disease; fat redistribution of the abdomen was defined as enlarged abdominal volume with reduced subcutaneous fat. Signs of LDS were divided into present and absent or unknown by appearance and examination.
Between July and October 2000, outpatients in an HIV-specialized unit at the University Hospital of Düsseldorf, Germany, underwent clinical evaluation and received a standardized written questionnaire. Of 389 patients eligible for analysis, 313 patients (80.5 percent response rate) returned completed questionnaires.
The prevalence of LDS was 37.7 percent (118 patients), manifesting as follows: lipoatrophy of the face in 103 patients (32.9 percent), abdominal fat redistribution in 53 patients (16.9 percent), and lipoatrophy of the extremities in 70 patients (22.4 percent). The presence of LDS had no significant influence on the self-assessment of general quality of health condition and the amount of disturbance of well-being by HIV infection. Participants with LDS felt recognizable as HIV-positive by physical appearance in 30.1 percent of cases, compared to 18.3 percent in patients without LDS. This difference became more pronounced after adjustment for gender, age, stage of disease, CD4 cell count, and duration of HAART.
Study authors concluded the presence of LDS does not seem to influence the attitude toward individual health condition and the feeling of well-being. However, patients presenting with lipodystrophy are about twice as likely to feel recognizable as HIV-positive by their physical appearance. LDS may thus be perceived as a characteristic mark of being HIV-positive by affected persons. A stigmatizing effect and social disadvantages may be the consequences, they wrote.
AIDS Patient Care and STDs
09.01.02; Vol. 16; No. 9: P. 413-417; Mark Oette, M.D.; Petra Juretzko, M.D.; Arne Kroidl, M.D.; Abdurrahman Sagir, M.D.; Matthias Wettstein, M.D.; Johannes Siegrist, M.D., M.P.H.; Dieter Häussinger, M.D.