A Comparison of Sonographic Assessments and Clinical Questionnaire in the Diagnosis of HIV-Associated Lipodystrophy

Abstract

The study evaluated the use of sonographic measurements as an alternative to assessments based on clinical or other imaging techniques for the diagnosis of body-fat abnormalities. The study enrolled 179 HIV-infected patients, 81 (45.3%) of them diagnosed as lipodystrophy (LD)-positive based on a clinical standard questionnaire. Association between clinical LD and sonographic measurements of face, right upper limb, subcutaneous abdomen, and visceral compartments was evaluated by multiple logistic regression. The predicted probability of the logistic model was 0.64, corresponding to a maximum sensitivity of 69.1% (58%-79%), a specificity of 94.9% (88%-98%), and to positive and negative predictive values of 92% (82%-97%) and 79% (70%-86%), respectively. Kappa measure of concordance was 65% (54%-77%). Low sensitivity poses a problem for the use of sonography to detect LD in the clinical routine as a single exam, speaking in favor of the combined use of clinical and sonographic measurements over time.

Improvement of HAART in Brazil, 1998–2008: a nationwide assessment of survival times after AIDS diagnosis among men who have sex with men

“…Other problems to be tackled by clinicians and health managers include the progressive, albeit moderate, increase of secondary resistance [ 34 ] and the permanent challenge posed by side effects of different antiretroviral medications, such as lipodystrophy and metabolic syndromes [ 35 ]. However, despite all such caveats and difficulties, the present paper documents a progressive increase of survival times among gay men over successive periods of the decade 1998–2008.…”

HIV/AIDS and lipodystrophy: Implications for clinical management in resource‐limited settings

“…Additional methods, such as MRI, are considered superior in assessment of body composition in the context of HIV, though are less widely available in lower-income settings. Other methods, such as ultrasound, have not been validated for lipodystrophy assessment [ 81 ], and vary considerably on the operator [ 82 ].…”

A longitudinal evaluation of the impact of a polylactic acid injection therapy on health related quality of life amongst HIV patients treated with anti-retroviral agents under real conditions of use

“…Consistent patient improvements observed in the photographs add weight to the validity of the results. Moreover, the efficacy of polyactic acid when compared to other treatments has been shown in several previous comparative studies [22,23,27-29]. A second limitation is the loss of patients to followup, though data available indicated that those lost had similar demographics and treatment outcomes in the early stages to those retained in the later stage.…”

“…Similar studies using generic QoL measures such as the SF-36 have sometimes failed to find significant treatment gains [22], while others have failed to show QoL differences between patients with and without lipodystrophy [4]. On the other hand, studies using the ABCD have reported comparable results [23,24]. …”

“…Moreover, comparative studies have shown greater patient-reported QoL gains resulting from reabsorbable (PLA) and non-reabsorbable [e.g. polyacrylamide hydrogel (PAAG)] filler injections when compared to autologous fat transfer (AFT) surgery [23]. This speaks to the value of including both patient and doctor perspectives as a method of evaluating condition improvement, and to the use of filler injection techniques as the treatment of choice.…”