Assessment of Ultrasound for Use in Detecting Lipoatrophy in HIV-Infected Patients Taking Combination Antiretroviral Therapy

Abstract

The aim of this study was evaluation of ultrasound (US) as a tool for the assessment of lipoatrophy in a population of HIV-infected patients. We enrolled a convenience sample of 151 HIV-infected Caucasian participants (males, 79%) who were treated for at least 1 year with combination antiretroviral therapy (CART) in Zagreb, Croatia. US measurements of subcutaneous fat thickness were done over the malar, brachial, and crural region. We determined sensitivity and specificity of US as a diagnostic tool for lipoatrophy using receiver-operating curves and concordant patient and clinician assessment as our reference for the presence of lipoatrophy. HIV was acquired through heterosexual contact in 50% of participants and by sex between men in 42%. The mean current CD4 cell count was 503.1 cells=mm 3 (standard deviation [SD] ¼ 250.8). Seventy-seven (51%) participants were treated with stavudine and 91 (64%) with a protease inhibitor for at least 6 months. Nineteen (13%) participants had lipoatrophy in at least one anatomic site. Sensitivity of US ranged from 67%-71%, specificity from 65%-71%, positive and negative predictive values ranged from 11%-20% and 96-97%, respectively. USdiagnosed lipoatrophy was more frequently found in patients with a history of stavudine treatment and in females. Patients with lipoatrophy had a longer duration of CART than those without lipoatrophy. US is a useful tool in ruling out the presence of clinical lipoatrophy in patients on CART. Using this objective measure of subcutaneous fat may be useful in helping clinicians make decisions about changing therapy.

Lipodystrophy: pathophysiology and advances in treatment

“…These techniques, however, are not used in everyday clinical practice due to cost and lack of availability. Ultrasound imaging is an emerging alternate quantitative tool that is accurate as well as comparatively affordable and accessible 5 .…”

Lipoatrofia facial associada ao HIV/AIDS: do advento aosconhecimentos atuais

“…Even though, they still regard the ultrasound as a potential tool for the evaluation of the patients, keeping in mind its low cost, accessibility and absence of radiation. 29 In view of all these limitations, the reports of loss or accumulation of fat in specific areas and the determination of the intensity level clinically evaluated and concordant between doctor and patient remain the best way of defining the problem individually. 27 Most studies about lipodystrophic syndrome are based on the presence of subjective symptoms reported by patients, on the presence of clinical signs observed at physical evaluation by the doctor or on the combination of both.…”

Facial Lipoatrophy and AIDS

“…Hendrickson et al (2009) also agree that lipoatrophy is one of the most common manifestations associated with the use of ARV and cite a frequency range of 13 to 63%. Viskovic et al (2009) believe that lipoatrophy is the most common and disfiguring of the body changes of the syndrome. They evaluated 151 patients with HIV, of whom about 39% reported lipoatrophy in some place, while about 45% of the physicians noticed fat loss in the clinical examination.…”