Body physical changes in HIV patients under antiretroviral treatment in Spain

Purpose of the study

Ten years have passed since the first cases of lipodystrophy were described and there are no real incidence data on the different body physical changes (BPCs) in the HIV population under antiretroviral treatment (ART) in Spain. A specific survey was designed to collect information about BPCs perceived by patients (pts) and their physicians.

Methods

The survey on BPCs consisted of two parallel questionnaires, for patient and physician. Ethics Committee approval was received and patient's informed consent was requested to participate. Estimating a 25% BPCs incidence (10% relative error) in the HIV+ Spanish population taking ART (>60,000 pts) and 20% surveys missing, a sample size of 1,020 pts was calculated for a multistage stratified sampling as follows: the 17 Autonomous Communities (ACs) were grouped in 12 strata and 102 physician-sites were allocated among stratum according to their weights [stratum sampling fraction 0.017 (0.014–0.026)]. In each centre, physician was selected by single random sampling, whereas the 10 patients to be surveyed were selected using systematic sampling with random start point from patients visiting the physician in January 2008. Results are shown as weighted rates based on the population per AC over the total surveyed sample (95% CI).

Summary of results

Finally, 965 patient-physician surveys were collected in 98 physician-sites: mean patient age was 43.7 ± 8.5 yrs, with 26.4% females and 39% IDU risk behavior. Median time on ART was 87 months (Q1–Q3, 41–126). 539 patients (55.1%, 95% CI: 52.0–58.1) answered positively to have perceived one or more BPCs as 55.2% physician did (95% CI: 52.1–58.2); there was 83.3% patient-physician overall agreement. The most frequent BPC perceived was lipoatrophy, followed by lipohypertrophy and color changes in the skin and in the eyes (see Table 1). Although no gender difference was shown for global BPCs incidence, more female patients perceived lipoatrophic events than male patients in arms (p = 0.009) and buttocks (p < 0.007).

Table 1 Body physical changes.

Conclusion

A high proportion of patients under ART in Spain refer changes in their physical appearance. The prevention of the potential negative impact of BPC on patients' self-esteem should be considered among the antiretroviral treatment end-points.