title: Lipodystrophy among HIV-infected patients: a cross-sectional study on impact on quality of life and mental health disorders.
abstract: BACKGROUND
  Lipodystrophy (LD) is a frequent adverse event of combination antiretroviral therapy (ART) and occurs mainly in patients exposed to first-generation antiretroviral drugs. The aim of this study was to explore and measure the interaction between LD, mental health, and quality of life of human immunodeficiency virus (HIV) positive individuals seen in a metabolic clinic.
  
  
  METHODS
  We conducted a single-site cross-sectional study including all HIV-infected patients attending the LIPO group and metabolism day clinic at the University Hospitals of Geneva, Switzerland between January 31, 2008 and November 28, 2013. Data on LD were prospectively collected using the HIV Outpatient Study (HOPS) score, the Lipodystrophy Case Definition (LDCD), ART regimens, anthropometric measures, imaging, and standardized questionnaires. Quality of life was evaluated using a visual analog scale of 0-100. Depression and anxiety were assessed using the Beck Depression Inventory and the State Trait Anxiety Inventory scales, respectively.
  
  
  RESULTS
  One hundred ninety-four patients (54.6% male; 45.4% female; median age, 50 years) on successful ART (median CD4 cell count, 569.0 cells/mm(3); median viral load, 20 copies/mL) were evaluated. Among these, 62.7, 63.5 and 35.5% of patients reported at least one body site affected by fat hypertrophy, atrophy or both, respectively. Using the LDCD score conservative definition, including imaging and biological values, 57.8% were diagnosed with LD. Of these, 39.7% suffered from severe/very severe LD. Depression was reported by 35.6% of individuals; 51.9% had anxiety symptoms and 49.5% reported poor quality of life (defined as being inferior to 50% on a scale from 0 to 100%). LD (odds ratio (OR = 5.22, 95% confidence interval (CI) 1.07-25.37, p-value: 0.040), depression (OR = 4.67, 95% CI 1.08-20.31, p-value 0.040), and anxiety (OR = 7.83, 95% CI 1.91-32.03, p-value 0.004) all affected significantly the quality of life.
  
  
  CONCLUSIONS
  LD, depression and anxiety were frequent features among HIV-infected individuals seen in the metabolic clinic and significantly impacted on their quality of life.
authors.affiliation: Department of Pediatrics, Children's Hospital-University Hospitals of Geneva, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Verolet
authors.affiliation: HIV Unit, Department of Infectious Diseases, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland.
authors.forename: Cécile
authors.initials: C
authors.lastname: Delhumeau-Cartier
authors.affiliation: HIV Unit, Department of Infectious Diseases, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland ; Department of Psychiatric Diseases, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland.
authors.forename: Marlène
authors.initials: M
authors.lastname: Sartori
authors.affiliation: Department of Psychiatric Diseases, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland.
authors.forename: Simona
authors.initials: S
authors.lastname: Toma
authors.affiliation: Department of Nuclear Medicine, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Zawadynski
authors.affiliation: Department of Radiology, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland.
authors.forename: Minerva
authors.initials: M
authors.lastname: Becker
authors.affiliation: Department of Infectious Diseases, Hospital of Lugano, Via Tesserete 46, 6900 Lugano, Switzerland.
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.affiliation: Department of Dermatology and Venerology, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland.
authors.forename: Laurence Toutous
authors.initials: LT
authors.lastname: Trellu
authors.affiliation: HIV Unit, Department of Infectious Diseases, University Hospitals of Geneva, 4, Rue Gabrielle-Perret-Gentil, 1211 Geneva 4, Switzerland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Calmy
keywords: Anxiety; Depression; HIV infection; Lipoatrophy; Lipodystrophy; Lipohypertrophy; Mental health disorder; Quality of life