title: HIV-associated facial lipoatrophy: establishment of a validated grading scale.
abstract: OBJECTIVE
  HIV-associated lipodystrophy is considered a sequela of highly active antiretroviral treatment. We describe the characteristics, possible etiology, and pathophysiology of HIV-associated lipodystrophy and facial lipoatrophy and establish a validated grading scale for HIV-associated facial lipoatrophy using evidence-based techniques.
  
  
  METHODS
  A grading scale was designed based on the severity of each patient's facial lipoatrophy. Preoperative photographs of HIV-infected patients seeking treatment for facial lipoatrophy and control subjects were reviewed by physicians qualified in facial plastic surgery. With use of the devised grading scale, each patient was assigned a severity score. These scores were then compared for interrater variability, and the distribution of scores was analyzed.
  
  
  RESULTS
  Preoperative photographs of 39 HIV-infected individuals with facial lipoatrophy and 6 normal subjects were obtained and reviewed. All patients were males. A Cohen kappa of 0.73 was calculated, and there was a fairly equal distribution of all severity grades throughout the 39 patients.
  
  
  CONCLUSIONS
  HIV-associated facial lipoatrophy is a major stigma for HIV patients that can have dramatic effects on their self-esteem, social habits, and medication compliance. This current study introduces a validated evidence-based grading scale that can be implemented to categorize disease severity. Using this scale will hopefully generate improved treatment plans directed to each patient, which should produce enhanced postoperative results.
authors.affiliation: Bobby R. Alford Department of Otolaryngology/Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Etai
authors.initials: E
authors.lastname: Funk
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Brissett
authors.forename: Craig D
authors.initials: CD
authors.lastname: Friedman
authors.forename: Fred J
authors.initials: FJ
authors.lastname: Bressler
mesh_terms: D000328:Adult; D005145:Face; D006678:HIV; D039682:HIV-Associated Lipodystrophy Syndrome / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D015187:Lipectomy; D008297:Male; D008875:Middle Aged; D010781:Photography; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index