Gender differences in depression evolution in a cohort of patients attending a metabolic clinic for lipodystrophy management

Purpose of the study

HIV-related body changes may stigmatise patients, producing erosion of self-image and self-esteem, problems in social and sexual relations, anxiety and depression. The purpose of our study was to evaluate gender differences in the evolution of depression among patients attending a metabolic clinic for lipodystrophy (LD) diagnosis and treatment.

Methods

Patients referring to Modena and Reggio Emilia University metabolic clinic, receiving multidisciplinary treatment for face or body LD, were enrolled. At baseline, biochemical, viro-immunological parameters, and LD diagnosis according to MACS classification were collected. At baseline and after 48 weeks, patients filled the Beck Depression Inventory Scale questionnaire (BDI, total possible scores range from 0 to 63; mild depression 9–17, moderate depression 18–29, severe depression above 30).

Summary of results

272 patients enrolled; 36.4% female; median age 47 (± 7) years; CDC group C 28.7%. At baseline, 59.2% had undetectable viral load and 91.9% had CD4 cell count above 200 cell/microl. 41.7% of patients had lipoatrophy, 2.6% lipohypertrophy, and 43.8% mixed forms. 72.4% of patients underwent surgical treatment for face lipoatrophy during the follow-up period (70.6% male, 29.4% female). At baseline, women median (IQR) BDI score was statistically significant higher than that of men: 13 (12) vs. 10 (10), p = 0.030. There was no statistically significant difference in BDI baseline median score comparing patients with or without LD and those with different forms of LD. After 48 weeks BDI median score improved significantly in the sample 11 (11) vs. 9.5 (12), p = 0.001, and in male patients 10 (10) vs. 9 (11), p = 0.001, but not significantly in women 13 (12) vs. 11 (14) p = 0.110, even distinguishing women on menopause or not. Among patients undergoing surgical treatment for face lipoatrophy, men only experienced a statistically significant improvement of BDI in the follow-up period: women 12.5 (15.7) vs. 12 (13.2) p = 0.114 and men 11 (10) vs. 9 (10) p < 0.0001.

Conclusion

As demonstrated in the general population, women with HIV infection seem to be more vulnerable than men to experience more severe depression symptoms that still remain even after face lipoatrophy treatment. This issue underlines the need for new studies analyzing the gender peculiarity of depression among patients with HIV infection.