title: Overcoming subjectivity in assessing facial lipoatrophy: is there a role for three-dimensional laser scans?
abstract: BACKGROUND
  Prevalence and incidence rates of lipodystrophy vary widely and frequently rely upon self- and/or clinician reports. Currently no validated assessment tool for facial lipoatrophy is available.
  
  
  OBJECTIVE
  To illustrate that assessment of the severity of facial lipoatrophy by patients and clinicians is subjective. To evaluate the reproducibility of facial three-dimensional surface laser scans.
  
  
  METHODS
  Twenty-three HIV-positive men were recruited from an inner London HIV outpatient clinic in September 2001. CD4 count, viral load, antiretroviral history and body mass index were recorded. Patients and clinicians independently assessed the severity of facial lipoatrophy on a four-point scale and the level agreement was measured. Seventeen of the 23 patients (73.9%) underwent two scans 1 week apart, which were then superimposed. The volume difference (mm3) and mean difference (mm) between the scans for five regions of the face were measured and compared with the self-reported grade of facial lipoatrophy.
  
  
  RESULTS
  For each pair of clinicians (P=0.03, 0.005 and 0.0002, respectively), and for one patient-clinician pair (P=0.004), there was a significant systematic difference between the two sets of gradings of facial lipoatrophy. The level of disagreement was generally higher for patients reporting facial lipoatrophy (n=17) compared to those not reporting it (n=6). The mean volume difference and mean difference between any region were within 200 mm3 and 0.25 mm, respectively. Reproducibility was unaffected by the self-reported grade of facial lipoatrophy.
  
  
  CONCLUSIONS
  Assessment of the severity of facial lipoatrophy by patients and clinicians is subjective. Three-dimensional facial laser scans are reproducible and may provide an objective tool for monitoring changes in facial lipoatrophy.
authors.affiliation: Department of Genitourinary Medicine, Mortimer Market Centre, London, UK. paul.benn@berkshire.nhs.uk
authors.forename: P
authors.initials: P
authors.lastname: Benn
authors.forename: C
authors.initials: C
authors.lastname: Ruff
authors.forename: J
authors.initials: J
authors.lastname: Cartledge
authors.forename: V
authors.initials: V
authors.lastname: Sauret
authors.forename: A
authors.initials: A
authors.lastname: Copas
authors.forename: A
authors.initials: A
authors.lastname: Linney
authors.forename: I G
authors.initials: IG
authors.lastname: Williams
authors.forename: C
authors.initials: C
authors.lastname: Smith
authors.forename: S G
authors.initials: SG
authors.lastname: Edwards
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005145:Face; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000592:standards; D007834:Lasers / Q000592:standards; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity