Cargando…
The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings
BACKGROUND: Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definition...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2014
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138415/ https://www.ncbi.nlm.nih.gov/pubmed/25143778 http://dx.doi.org/10.1186/1742-6405-11-26 |
_version_ | 1782331232837697536 |
---|---|
author | Abrahams, Zulfa Dave, Joel A Maartens, Gary Lesosky, Maia Levitt, Naomi S |
author_facet | Abrahams, Zulfa Dave, Joel A Maartens, Gary Lesosky, Maia Levitt, Naomi S |
author_sort | Abrahams, Zulfa |
collection | PubMed |
description | BACKGROUND: Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definitions have been developed to diagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less visceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple, objective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and dual-energy X-ray absorptiometry (DXA) -derived variables. METHODS: DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South African men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected using a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance of anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference standard. RESULTS: Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men (10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best predictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC =0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb fat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip ratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647). CONCLUSIONS: We were able to develop simple, anthropometric measures for defining lipoatrophy and lipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing patients with lipoatrophy and lipohypertrophy. |
format | Online Article Text |
id | pubmed-4138415 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-41384152014-08-21 The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings Abrahams, Zulfa Dave, Joel A Maartens, Gary Lesosky, Maia Levitt, Naomi S AIDS Res Ther Research BACKGROUND: Lipohypertrophy does not appear to be an adverse ART reaction while lipoatrophy is clearly associated with the use of stavudine (d4T) and zidovudine (AZT). In low and middle income countries d4T has only recently been phased out and AZT is still widely being used. Several case definitions have been developed to diagnose lipodystrophy, but none of them are generalizable to sub-Saharan Africa where black women have less visceral adipose tissue and more subcutaneous adipose tissue than white women. We aimed to develop a simple, objective measure to define lipoatrophy and lipohypertrophy by comparing patient report to anthropometric and dual-energy X-ray absorptiometry (DXA) -derived variables. METHODS: DXA and anthropometric measures were obtained in a cross sectional sample of black HIV-infected South African men (n = 116) and women (n = 434) on ART. Self-reported information on fat gain or fat loss was collected using a standard questionnaire. Receiver operating characteristic (ROC) curves were used to describe the performance of anthropometric and DXA-derived variables using patient reported lipoatrophy and lipohypertrophy as the reference standard. RESULTS: Lipoatrophy and lipohypertrophy were more common in women (25% and 33% respectively) than in men (10% and 13% respectively). There were insufficient numbers of men with DXA scans for meaningful analysis. The best predictors of lipoatrophy in women were the anthropometric variables tricep (AUC = 0.725) and thigh skinfold (AUC =0.720) thicknesses; and the DXA-derived variables percentage lower limb fat (AUC = 0.705) and percentage lower limb fat/height (AUC = 0.713). The best predictors of lipohypertrophy in women were the anthropometric variable waist/hip ratio (AUC = 0.645) and the DXA-derived variable percentage trunk fat/percentage limb fat (AUC = 0.647). CONCLUSIONS: We were able to develop simple, anthropometric measures for defining lipoatrophy and lipohypertrophy, using a sample of black HIV-infected South African women with DXA scans. This is of particular relevance in resource limited settings, where health professionals need simple and inexpensive methods of diagnosing patients with lipoatrophy and lipohypertrophy. BioMed Central 2014-08-04 /pmc/articles/PMC4138415/ /pubmed/25143778 http://dx.doi.org/10.1186/1742-6405-11-26 Text en Copyright © 2014 Abrahams et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Abrahams, Zulfa Dave, Joel A Maartens, Gary Lesosky, Maia Levitt, Naomi S The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings |
title | The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings |
title_full | The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings |
title_fullStr | The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings |
title_full_unstemmed | The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings |
title_short | The development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings |
title_sort | development of simple anthropometric measures to diagnose antiretroviral therapy-associated lipodystrophy in resource limited settings |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138415/ https://www.ncbi.nlm.nih.gov/pubmed/25143778 http://dx.doi.org/10.1186/1742-6405-11-26 |
work_keys_str_mv | AT abrahamszulfa thedevelopmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT davejoela thedevelopmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT maartensgary thedevelopmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT lesoskymaia thedevelopmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT levittnaomis thedevelopmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT abrahamszulfa developmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT davejoela developmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT maartensgary developmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT lesoskymaia developmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings AT levittnaomis developmentofsimpleanthropometricmeasurestodiagnoseantiretroviraltherapyassociatedlipodystrophyinresourcelimitedsettings |