title: Assessment of ultrasound for use in detecting lipoatrophy in HIV-infected patients taking combination antiretroviral therapy.
abstract: The aim of this study was evaluation of ultrasound (US) as a tool for the assessment of lipoatrophy in a population of HIV-infected patients. We enrolled a convenience sample of 151 HIV-infected Caucasian participants (males, 79%) who were treated for at least 1 year with combination antiretroviral therapy (CART) in Zagreb, Croatia. US measurements of subcutaneous fat thickness were done over the malar, brachial, and crural region. We determined sensitivity and specificity of US as a diagnostic tool for lipoatrophy using receiver-operating curves and concordant patient and clinician assessment as our reference for the presence of lipoatrophy. HIV was acquired through heterosexual contact in 50% of participants and by sex between men in 42%. The mean current CD4 cell count was 503.1 cells=mm3 (standard deviation [SD] = 250.8). Seventy-seven (51%) participants were treated with stavudine and 91 (64%) with a protease inhibitor for at least 6 months. Nineteen (13%)participants had lipoatrophy in at least one anatomic site. Sensitivity of US ranged from 67%-71%, specificity from 65%-71%, positive and negative predictive values ranged from 11%-20% and 96-97%, respectively. US diagnosed lipoatrophy was more frequently found in patients with a history of stavudine treatment and in females. Patients with lipoatrophy had a longer duration of CART than those without lipoatrophy. US is a useful tool in ruling out the presence of clinical lipoatrophy in patients on CART. Using this objective measure of subcutaneous fat may be useful in helping clinicians make decisions about changing therapy.
authors.affiliation: Department of Radiology, University Hospital for Infectious Diseases "Dr. F. Mihaljevic", Mirogojska Cesta 8, 10000 Zagreb, Croatia. viskovick@yahoo.com
authors.forename: Klaudija
authors.initials: K
authors.lastname: Viskovic
authors.forename: Ilana
authors.initials: I
authors.lastname: Richman
authors.forename: Ksenija
authors.initials: K
authors.lastname: Klasnic
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hernandez
authors.forename: Ivan
authors.initials: I
authors.lastname: Krolo
authors.forename: George W
authors.initials: GW
authors.lastname: Rutherford
authors.forename: Vanja
authors.initials: V
authors.lastname: Romih
authors.forename: Josip
authors.initials: J
authors.lastname: Begovac
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017523:Croatia; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects; D039682:HIV-Associated Lipodystrophy Syndrome / Q000139:chemically induced / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012680:Sensitivity and Specificity; D018119:Stavudine / Q000008:administration & dosage / Q000627:therapeutic use; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D018119:Stavudine