Lipodystrophy in HIV - infected patients attending HIV clinic at Muhimbili national hospital
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Date
2013
Authors
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Journal ISSN
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Publisher
Hubert Kairuki Memorial University
Abstract
Background: The use of highly active antiretroviral therapy (HAART) has decreased morbidity
and mortality rate associated with HIV infection. HAART is associated with increased incidence
of morphological and metabolic changes, including hyperlipidaemia and hyperglycaemia, insulin
resistance. These metabolic changes may increase the risk for cardiovascular disease and the
morphological changes have significant psychological impact.
The prevalence of HIV lipodystrophy is not well established so far, and no data has been reported
in Tanzania, therefore, there is a need to conduct a comprehensive study to determine the
prevalence of lipodystrophy and serum biochemical changes in HIV infected patients who are on
HAART at Muhimbili National Hospital, Dar es salaam, Tanzania.
Study objective: To determine the prevalence of lipodystrophy and metabolic changes in HIV
infected patients on HAART for at least one year at the HIV clinic in MNH.
Methodology: This was a descriptive cross sectional study at the HIV clinic at MNH, during
November 2010 to December 2010. Study population included HIV infected patients attending
HIV/AIDS clinic at MNH, who were on HAART for more than I year. The subjects were
obtained by systematic random sampling technique. Data collection included interview using
standardized structured questionnaire, lipodystrophy was defined as self- reporting and clinical
examination, explanatory variables investigated included age, sex, duration of HIV disease,
duration of HAART used, BMI, Waist-to Hip ratio, serum total cholesterol, serum triglycerides,
fasting blood glucose
Data analysis was done by statistical package for social science (SPSS) version 13. The
associations of different variables and presence of lipodystrophy was compared using the
Student's t-test for continuous variables and the Pearson's jl test or Fisher's Exact test for
categorical data was analyzed. A multivariate analysis was performed by multiple logistic
regression analysis to determine the independent predictors of lipodystrophy. A two-sided P
value < 0.05 was considered statistically significant.
Results: A total of 239 HIV- infected patients participated in the study with 68.7% female and
the participants mean age was 45.4 (range from 20 - 67 years). Forty four percent were
diagnosed to have HIV for more than 5 years and 78.2% were on ARV's for more than 3 years.
Lipodystrophy was observed in 27.6% (n=66). Among study participants with lipodystrophy 20
(8.4%) had lipoatrophy, 15 (6.3%) had lipohypertrophy and 31 (13.0%) participants had mixed
type. By univariate analysis the prevalence of lipodystrophy was significantly associated with
increased duration of HIV disease (P=0.007), increased duration of HAART use (P=0.009),
systolic blood pressure (P=0.017), body mass index (P=0.011), high female waist- to- hip ratio
(P= 0.001), fasting blood glucose (0.038), serum triglyceride (0.016). When a multivariate
logistic regression analysis was performed, duration of HIV disease (p= 047), and female waist
to hip ratio (p= 0.041) were independently associated with Lipodystrophy in HIV infected
patients.
Conclusion
The prevalence of lipodystrophy is high (27.6%) among HIV infected patients. Lipodystrophy
was significantly associated with increased duration of HIV disease, increased duration of
HAART use, body mass index, female waist-to-hip ratio, high serum triglyceride and fasting
blood glucose. This highly prevalence of lipodystrophy does not only contribute to an accelerated
risk of premature atherosclerosis and cardiovascular events among HIV Infected patients; but
also its morphological changes to individuals may lead to psychosocial stigmatization, reduced
self esteem and poor adherence to HAART.
Recommendation
Routine assessment of HIV lipodystrophy and its risk factors among HIV infected patients
should be essential part of HIV/AIDS Treatment and Care. This will facilitate early vigilant
diagnosis and timely intervention of lipodystrophy and metabolic alterations, including
cardiovascular risk factors.
Description
A dissertation submitted as a partial fulfillment of the requirements for the
Master of Medicine degree in Internal Medicine of the
Hubert Kairuki Memorial University
Keywords
HIV, Lipodystrophy, Muhimbili National Hospital
Citation
Khan, G. M. H., 2013. Lipodystrophy in HIV - infected patients attending HIV clinic at Muhimbili National Hospital.HKMU