title: HIV-associated lipodystrophy in South Africa: the impact on the patient and the impact on the plastic surgeon.
abstract: BACKGROUND
  With 67% of the world's human immunodeficiency virus (HIV)-infected population existing in sub-Saharan Africa and recent access to highly active antiretroviral therapy (HAART), the demand for plastic surgical intervention in addressing lipodystrophy has expanded dramatically. We assessed the rate of lipodystrophy in a random clinic cohort, the demand for surgical correction and risk of treatment non-compliance.
  
  
  METHODS
  Questionnaire and database cross-sectional review of 554 patients over a 3-month period at the Themba Lethu Clinic, Johannesburg, South Africa.
  
  
  RESULTS
  A total of 479 patients completed the questionnaire, 83% were female. Nearly 90% of patients were on, or had been on, stavudine (d4T). The prevalence of lipodystrophy was 11.7%. Nearly 5.9% of patients had considered stopping treatment due to the development of lipodystrophy; 47% would consider surgery to correct unwanted physical changes. Male patients were satisfied by the changes they noted in their physical features following treatment (pre-treatment satisfaction 38% vs. post-treatment satisfaction of 94%). Female patients had 6.5 times more breast hypertrophy-related symptoms than in their pre-treatment state.
  
  
  CONCLUSIONS
  We identify a prevalence of 11.7% of patients with HIV-associated lipodystrophy, of whom 5.9% would consider non-compliance on the basis of this side effect alone. The demand for surgical correction is significant and needs to be addressed.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. richard.zinn@gmail.com
authors.forename: Richard Joseph
authors.initials: RJ
authors.lastname: Zinn
authors.forename: Charles
authors.initials: C
authors.lastname: Serrurier
authors.forename: Simba
authors.initials: S
authors.lastname: Takuva
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.forename: Colin Nigel
authors.initials: CN
authors.lastname: Menezes
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D005260:Female; D039682:HIV-Associated Lipodystrophy Syndrome / Q000453:epidemiology* / Q000523:psychology* / Q000601:surgery; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures / Q000523:psychology*; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires