Lipodystrophy has uneven impact on quality of life, says study

Developing lipodystrophy does not, in itself, negatively affect quality of life, according to a Spanish study reported in the Journal of Acquired Immune Deficiency Syndromes. However, the study conducted in Barcelona found that gay men, people out of work, and those receiving treatment for psychiatric disorders were more likely to report reduced quality of life if they had body changes associated with lipodystrophy.

Investigators recruited 150 people from a specialist HIV clinic over a six-month period. To be included in the study it was necessary to be clinically stable, to have received at least one year of HAART, and to be capable of understanding the study questionnaire. In a structured interview with a psychologist, people were asked their age, sexual orientation, whether or not they were in a relationship, social class, employment status and whether or not they were now or had been treated for a psychiatric disorder. The trial participants were then asked to assess their own psychological and physical status on a scale ranging from one (very bad) to ten (very good). Psychological status included a person’s ability to relax, sleep, eat and enjoy recreation. Physical status included ability to perform heavy work, manage day-to-day tasks and concentrate.

To find out the extent and severity of HAART-related side-effects, people in the study were asked to grade side-effects on a scale of one to five - with one being no side-effects, and five being an adverse effect so severe that it necessitated a change in treatment. Symptoms of lipodystrophy were self reported and patients were asked if they had experienced changes to the shape of their face, neck, arms, breast, abdomen, buttocks and legs. Those reporting at least one body shape change were regarded as having lipodystrophy. A self-completed questionnaire including 40 questions designed to assess physical capacity, psychological functioning, positive mood, negative mood, social functioning and social well-being was then administered.

Information about time of HIV diagnosis, current CD4 count and viral load, history of HIV-related illnesses and prior HAART therapy was obtained from the patients’ medical records.

Symptoms of lipodystrophy were reported by 56% (84 people) of the study sample, with 72 patients reporting two or more body shape changes. People reporting lipodystrophy were older, had been taking HAART longer and were more likely to report ill health.

As regards the impact of lipodystrophy on quality of life, the investigators note “to our surprise, we did not find differences in overall q[uality] o[f] l[ife] between patients associated with the presence of absence of lipodystrophy. However, we noted that some patient-related characteristics were associated with a greater impact [on life quality]," adding, “homosexual men and patients with current psychiatric treatment with lipodystrophy seem to show a greater impairment [in quality of life]." In particular the investigators found that gay men, the unemployed, and people receiving current psychiatric therapy with HAART-related body fat changes were more likely to report reduced quality of life.

When the results were further analysed it was found that gay men with lipodystrophy were more likely to report that they had psychological problems such as relaxing, sleeping, and eating, whilst people receiving psychiatric treatment with lipodystrophy were more likely to report having physical problems.

The investigators conclude that it is necessary to design “strategies” to improve the quality of life of people with lipodystrophy and that “special attention should be paid to vulnerable subgroups such as homosexual men and patients with psychiatric disorders.”

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