HIV Lipodystrophy Syndrome: A Primer

Comparing Efficacy and Costs of Four Facial Fillers in Human Immunodeficiency Virus-Associated Lipodystrophy: A Clinical Trial

BACKGROUND

The objective of this study was to evaluate and compare the safety and effectiveness of four different dermal fillers in the treatment of facial lipoatrophy secondary to human immunodeficiency virus.

METHODS

The authors conducted a clinical trial including 147 patients suffering from human immunodeficiency virus-induced lipoatrophy treated with Sculptra (poly-L-lactic acid), Radiesse (calcium hydroxylapatite), Aquamid (polyacrylamide), or autologous fat. Objective and subjective changes were evaluated during a 24-month follow-up. Number of sessions, total volume injected, and overall costs of treatment were also analyzed. A comparative cost-effectiveness analysis of the treatment options was performed.

RESULTS

Objective improvement in facial lipoatrophy, assessed by the surgeon in terms of changes from baseline using the published classification of Fontdevila, was reported in 53 percent of the cases. Patient self-evaluation showed a general improvement after the use of facial fillers. Patients reported being satisfied with the treatment and with the reduced impact of lipodystrophy on their quality of life. Despite the nonsignificant differences observed in the number of sessions and volume, autologous fat showed significantly lower costs than all synthetic fillers (p < 0.05).

CONCLUSIONS

Surgical treatment of human immunodeficiency virus-associated facial lipoatrophy using dermal fillers is a safe and effective procedure that improves the aesthetic appearance and the quality of life of patients. Permanent fillers and autologous fat achieve the most consistent results over time, with lipofilling being the most cost-effective procedure.

Beneficial effects of physical activity in an HIV-infected woman with lipodystrophy: a case report

Introduction

Lipodystrophy is common in patients infected with human immunodeficiency virus receiving highly active antiretroviral therapy, and presents with morphologic changes and metabolic alterations that are associated with depressive behavior and reduced quality of life. We examined the effects of exercise training on morphological changes, lipid profile and quality of life in a woman with human immunodeficiency virus presenting with lipodystrophy.

Case presentation

A 31-year-old Latin-American Caucasian woman infected with human immunodeficiency virus participated in a 12-week progressive resistance exercise training program with an aerobic component. Her weight, height, skinfold thickness, body circumferences, femur and humerus diameter, blood lipid profile, maximal oxygen uptake volume, exercise duration, strength and quality of life were assessed pre-exercise and post-exercise training. After 12 weeks, she exhibited reductions in her total subcutaneous fat (18.5%), central subcutaneous fat (21.0%), peripheral subcutaneous fat (10.7%), waist circumference (WC) (4.5%), triglycerides (9.9%), total cholesterol (12.0%) and low-density lipoprotein cholesterol (8.6%). She had increased body mass (4.6%), body mass index (4.37%), humerus and femur diameter (3.0% and 2.3%, respectively), high-density lipoprotein cholesterol (16.7%), maximal oxygen uptake volume (33.3%), exercise duration (37.5%) and strength (65.5%). Quality of life measures improved mainly for psychological and physical measures, independence and social relationships.

Conclusions

These findings suggest that supervised progressive resistance exercise training is a safe and effective treatment for evolving morphologic and metabolic disorders in adults infected with HIV receiving highly active antiretroviral therapy, and improves their quality of life.

The pilot study of DXA assessment in chinese HIV-infected men with clinical lipodystrophy

The aim of this study was to evaluate human immunodeficiency virus (HIV)-infected patient's body composition changes by dual-energy X-ray absorptiometry (DXA) and to analyze factors associated with lipodystrophy (LD). Total-body composition was measured by DXA in HIV-infected men and healthy men. HIV-infected men were divided into LD patients and non-LD patients according to whether they were complicated with LD. Healthy men were selected as controls. Fat mass (FM) of HIV-infected patients correlated negatively with the duration of HIV infection and with the duration of highly active antiretroviral therapy regimen (r(s)=-0.448 and -0.563; p=0.032 and 0.000, respectively). Multiple linear regression results showed that FM had positive correlation with weight and bone mineral content (BMC) and had negative correlation with lean mass (LM). Total body and regional FMs were found to be significantly different among LD patients, non-LD patients, and controls-the lowest in LD patients and the highest in controls (p<0.05). Total body, trunk, and leg BMCs of LD patients were lower than those of controls (p<0.05). Lumbar bone mineral density of LD patients was lower than that of non-LD patients and controls (p=0.04 and 0.007). LM of LD patients was higher than that of non-LD patients, and trunk LM had statistical difference between the 2 groups (p=0.003). Applying DXA to assess HIV-infected patient's body composition changes could provide objective information for physicians to prevent LD and osteoporosis.

Treinamento físico na síndrome lipodistrófica: revisão sistemática

Com a cronicidade da infecção pelo HIV, a partir do uso da terapia antirretroviral combinada (TARV), o indivíduo torna-se predisposto às alterações metabólicas e corporais denominadas síndrome lipodistrófica, que têm como consequência o risco aumentado para doenças cardiovasculares. Tornam-se necessários estudos com viabilidades terapêuticas com o intuito de melhorar a qualidade de vida destes pacientes. Neste contexto, o treinamento físico deve ser abordado como terapêutica para minimizar os efeitos deletérios da TARV. O objetivo desse artigo foi revisar na literatura as evidências científicas sobre o treinamento físico na síndrome lipodistrófica. O método utilizado foi uma revisão sistemática com a localização de artigos publicados entre 2000 e 2008 nas bases de dados PubMed e SciELO. As evidências científicas encontradas nos estudos analisados indicam que a maioria dos estudos, independente do tipo de treinamento, obtiveram melhoria significativa na composição corporal. Dessa forma, tornam-se necessário mais estudos investigando o treinamento físico no perfil lipídico, na resistência a insulina e nas alterações glicêmicas em pessoas vivendo com HIV/Aids.

HIV/AIDS e Treinamento Concorrente: a Revisão Sistemática

O uso da terapia anti-retroviral combinada (TARV) aumentou a expectativa de vida dos portadores do vírus da imunodeficiência humana (HIV) e, como conseqüência, torna-se constante o estudo do processo fisiopatológico da infecção e das estratégias de intervenção que possam melhorar a qualidade de vida destes indivíduos. O treinamento concorrente, definido como a associação dos componentes aeróbios e força na mesma sessão de exercícios pode ser inserido neste contexto. O objetivo deste artigo é revisar os aspectos centrais da infecção pelo HIV e as evidências existentes sobre o treinamento concorrente com séries múltiplas e simples nos parâmetros imunológico, virológico, cardiorrespiratório e neuromuscular de pessoas infectadas pelo HIV. O método utilizado foi uma revisão sistemática, com artigos publicados entre 2000-2007, nas bases de dados scielo e pubmed e também em dissertações e teses da biblioteca digital da educação física, esporte e saúde. As evidências científicas encontradas nos 8 estudos analisados indicam que o treinamento concorrente, tanto com séries múltiplas quanto séries simples, melhora os parâmetros cardiorrespiratório e neuromuscular; no entanto, os resultados dos parâmetros imunológico e virológico ainda não estão completamente esclarecidos, principalmente sobre os protocolos com séries simples. Considerando o número restrito de trabalhos apresentados, sugere-se o desenvolvimento de estudos com treinamento concorrente em vários desfechos clínicos para pessoas infectadas pelo HIV.

Scoping the field: identifying key research priorities in HIV and rehabilitation

The purpose of this project was to identify key research priorities related to HIV and rehabilitation. We conducted a scoping study which included a literature review of published and grey literature, followed by focus group and interview consultations with 28 participants including people living with HIV, researchers, educators, clinicians, and policy makers with expertise in HIV and rehabilitation. Qualitative content analysis was used to identify emergent themes related to research priorities in HIV and rehabilitation. The resulting Framework of HIV and Rehabilitation Research provided an outline for approaching research in the field. The framework included three overlapping research priorities: (a) living with HIV across the lifespan, (b) disability, and (c) rehabilitation that should be viewed through environmental and/or personal contextual lenses, using different methodological approaches. Six key research priorities from this framework were identified through additional consultation with new and returning participants including: (1) disability and episodic disability, (2) concurrent health conditions aging with HIV, (3) HIV and the brain, (4) labour force and income support, (5) access to and effectiveness of rehabilitation, and (6) development and evaluation of outcome measurement tools. These priorities inform a future plan for HIV and rehabilitation research that will increase our knowledge to enhance practice, programming and policy for people living with HIV.

Effects of high-intensity endurance and resistance exercise on HIV metabolic abnormalities: a pilot study

The purposes of this pilot study were to examine the effects of a 16-week supervised high-intensity combined endurance and resistance exercise training program on HIV-associated metabolic abnormalities (abdominal adiposity, dyslipidemia, and insulin resistance) and to explore methodological issues related to the design and implementation of the research protocol in preparation for a randomized controlled trial. A one-group pretest-posttest design was used, with outcomes measured at baseline and within 1 week after the conclusion of the training program. The exercise program consisted of 16 weeks (preceded by a 2-week phase-in period) of three endurance sessions (20 min at 70%-80% of VO (2max)) and two resistance sessions per week (one set of 8-10 repetitions at 80% of one-repetition maximum on seven exercises). Outcome measures included lipid levels (total, high-density lipoprotein, and low-density lipoprotein cholesterol and triglycerides), visceral and subcutaneous adipose area measured by electron beam tomography, fat and lean mass of trunk and limbs measured by dual-energy X-ray absorptiometry, and insulin sensitivity measured by the homeostatic model assessment. Nine participants were recruited, 5 of whom completed the intervention and had pretest and posttest data available for analyses. Aerobic capacity and strength improved over the course of the intervention. Statistically significant decreases were found for total and trunk fat mass (1,324.9 g [+/-733.6] and 992.8 g [+/-733.6], respectively). Triglycerides decreased by 59 mg/dL (+/-69.88), and insulin sensitivity decreased by 15.7% (+/-41.7%), neither of which was a statistically significant change. Results suggest that further testing of the combined exercise intervention in a randomized controlled design is warranted.

Vulnerability, unsafe sex and non-adherence to HAART: Evidence from a large sample of French HIV/AIDS outpatients

Current socio-behavioural research in HIV-infected people has tried to identify patients with "high-risk" profiles, i.e. who simultaneously exhibit non-adherence to highly active anti-retroviral therapy (HAART) and unsafe sex with serodiscordant partners. We challenged this approach by investigating the correlates of both behaviours, for homosexual men, heterosexual men and heterosexual women separately, among a representative sample of 4963 HIV-infected people in France. Variables introduced in the analysis dealt with patients' background and daily life, with a focus on situations of economic, social and personal vulnerability. Overall, 2932 patients agreed to participate, and 1809 were both receiving HAART and sexually active. Among heterosexual women, non-adherence and unsafe sex appeared as joint outcomes of similar situations of vulnerability. Among heterosexual men, these behaviours were weakly correlated and shared some predictors related to situations of vulnerability. Among homosexual men, non-adherence and unsafe sex were not correlated and had distinct determinants. Situations of vulnerability, the context and the motives of unsafe sex, as well as factors associated with non-adherence and unsafe sex varied greatly with gender and sexual preference. Theoretical models used for designing behavioural interventions should take into account this diversity.

Self-perception of body changes in persons living with HIV/AIDS: prevalence and associated factors

BACKGROUND

Highly active antiretroviral therapy has brought about a substantial improvement in the prognosis of HIV/AIDS. In this context, therapy-related body changes (lipodystrophy) gain in importance, in light of the psychological distress they cause and of their association with adherence to treatment. This study analyses patients' self-perception of central fat gain (CFG) and peripheral fat loss (PFL).

METHODS

A total of 457 patients were interviewed in a university outpatient facility for the treatment of adults and adolescents with HIV/AIDS in the city of São Paulo, Brazil, between September and December 2001.

RESULTS

Two-thirds of subjects (64.3%) perceived body changes. The self-perception of CFG and PFL was associated with greater schooling. The self-perception of CFG was more frequent among women and in patients who used protease inhibitors for longer periods. The self-perception of PFL was more frequent among older patients, patients who used stavudine for longer periods, and patients who reported a lack of adherence to antiretroviral agents. The quality of affective/social relationships with friends and family was inversely associated with the self-perception of PFL.

CONCLUSION

The evaluation of self-perceived body changes and their determinants in individuals living with HIV/AIDS may help improve provided care. Listening to what patients have to say concerning antiretroviral therapy-related body changes and how they perceive them, as well as including the patient in therapeutic decisions in this regard will contribute towards greater adherence to proposed interventions and towards an improvement in the quality of life.

Laser scanning as a tool for assessment of HIV-related facial lipoatrophy: evaluation of accuracy and reproducibility

BACKGROUND

Facial lipoatrophy (LA) is a common complication of highly active antiretroviral therapy (HAART). Research into causes and treatment of facial LA is hindered by the lack of an objective measurement tool.

OBJECTIVE

To evaluate the accuracy and reproducibility of three-dimensional laser scanning (LS) for estimating cheek volume changes.

METHODS

Paired laser scans were performed and the images superimposed using commercial software. The volume difference between images was computed within a circle of radius 25 mm placed in a standardized position over the cheek area. Accuracy was tested by scanning before and after known volumes of plasticine (0.5--5 mL) were applied to the cheek area of a mannequin to simulate volume change. Reproducibility was tested by repeated scanning of the mannequin with and without 2 mL of plasticine, and repeated scanning of 10 healthy subjects over the course of 1 week.

RESULTS

The mean difference between actual and estimated volume change was small across the range of volumes tested [mean difference 0.08 mL; 95% confidence interval (CI)-0.36 to 0.20 mL). The coefficient of variation for repeated measurements of 2-mL volume change was 5.8%. The intraclass correlation coefficient for scan-to-scan variability was 0.812 (95% CI 0.515--0.947) and for day-to-day variability it was 0.764 (95% CI 0.332--0.935). Conclusions LS is an accurate and reproducible method for estimating cheek volume changes. It may be useful as an objective tool for assessment of facial LA in clinical research studies.

Lipodystrophy and quality of life in HIV: symptom management issues

The purpose of this study was to examine the incidence and prevalence of lipodystrophy-related symptoms in persons with HIV ( n = 165) and to determine the impact of these symptoms on health-related quality of life. Since the introduction of highly active antiretroviral therapy in HIV, the quality of life of persons is affected across the spectrum of the disease. The sample was composed of 165 persons from three national outpatient HIV settings (clinics and community-based organizations) in Boston, MA, Fresno, CA, and Victoria, TX. The descriptive, cross-sectional study included self-report instruments measuring lipodystrophy-associated symptom presence, intensity, and quality of life. The sample was primarily male (75.8%), with ethnicity represented across several groups including African American (30.9%), Hispanic/Latino (26.7%), White/Anglo (38.8%), Native American/Indian (1.8%), and other (1.8%). On quality-of-life measures, only 7.9% of the sample indicated excellent health, 28.5% indicated very good health, 22.4% indicated good health, and more than 40% indicated fair or poor health. Most of the participants indicated that aspects of their quality of life have equally good and bad parts (37.6%). Quality of life was significantly correlated with adequacy of income ( r = .241, p = .002), most recent CD4 count ( r = -.276, p = .012), and most recent viral load value ( r = .379, p = .019). In addition, bodily pain was significantly correlated with most recent CD4 count ( r = -.312, p = .004) and with lowest CD4 count ( r = -.191, p = .050). The results of the study indicate that quality of life is affected by HIV symptoms and that lipodystrophy-related symptoms may negatively affect quality of life.