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BMC Public Health
Published in: BMC Public Health 1/2018

Open Access 01-12-2018 | Research article

Lipodystrophy diagnosis in people living with HIV/AIDS: prediction and validation of sex-specific anthropometric models

Authors: André P. dos Santos, Anderson M. Navarro, Andiara Schwingel, Thiago C. Alves, Pedro P. Abdalla, Ana Claudia R. Venturini, Rodrigo C. de Santana, Dalmo R. L. Machado

Published in: BMC Public Health | Issue 1/2018

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Abstract

Background

Body composition alterations, or lipodystrophy, can lead to serious health problems in people living with HIV/AIDS (PLWHA). The objectives of this study are to predict and validate sex-specific anthropometric predictive models for the diagnosis of lipodystrophy in PLWHA.

Methods

A cross-sectional design was employed to recruit 106 PLWHA (men = 65 and women = 41) in Brazil during 2013–2014. They were evaluated using dual-energy X-ray absorptiometry, and 19 regions of body perimeters and 6 skinfold thicknesses were taken. Sex-specific predictive models for lipodystrophy diagnosis were developed through stepwise linear regression analysis. Cross-validations using predicted residual error sum of squares was performed to validate each predictive model.

Results

Results support the use of anthropometry for the diagnosis of lipodystrophy in men and women living with HIV/AIDS. A high power of determination with a small degree of error was observed for lipodystrophy diagnosis for men in model six (r2 = 0.77, SEE = 0.14, r2PRESS = 0.73, SEE PRESS = 0.15), that included ratio of skinfold thickness of subscapular to medial calf, skinfold thickness of thigh, body circumference of waist, formal education years, time of diagnosis to HIV months, and type of combined antiretroviral therapy (cART) (with protease inhibitor “WI/PI = 1” or without protease inhibitor “WO/PI = 0”); and model five for women (r2 = 0.78, SEE = 0.11, r2PRESS = 0.71, SEE PRESS = 0.12), that included skinfold thickness of thigh, skinfold thickness of subscapular, time of exposure to cART months, body circumference of chest, and race (Asian) (“Yes” for Asian race = 1; “No” = 0).

Conclusions

The proposed anthropometric models advance the field of public health by facilitating early diagnosis and better management of lipodystrophy, a serious adverse health effect experienced by PLWHA.
Literature
1.
2.
Programme UND: UNDP. Human development report: The Rise of the South: Human Progress in a Diverse World. 2013, 2016.
3.
FDA UFDA: Antiretroviral drugs used in the treatment of HIV infection. 2016.
4.
Mor Z, Sheffer R, Chemtob D. Causes of death and mortality trends of all individuals reported with HIV/AIDS in Israel, 1985–2010. J Public Health. 2017;40:1–9.
5.
Teeraananchai S, Kerr S, Amin J, Ruxrungtham K, Law M. Life expectancy of HIV-positive people after starting combination antiretroviral therapy: a meta-analysis. HIV medicine. 2017;18(4):256–66.CrossRefPubMed
6.
Eyawo O, Franco-Villalobos C, Hull MW, Nohpal A, Samji H, Sereda P, Lima VD, Shoveller J, Moore D, Montaner JS. Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis. 2017;17(1):174.CrossRefPubMedPubMedCentral
7.
8.
Strijdom H, De Boever P, Walzl G, Essop MF, Nawrot TS, Webster I, Westcott C, Mashele N, Everson F, Malherbe ST. Cardiovascular risk and endothelial function in people living with HIV/AIDS: design of the multi-site, longitudinal EndoAfrica study in the western Cape Province of South Africa. BMC Infect Dis. 2017;17(1):41.CrossRefPubMedPubMedCentral
9.
Perazzo H, Luz PM. Liver disease and healthy life-expectancy with HIV. Lancet HIV. 2017;4(6):e236–7.CrossRefPubMed
10.
Gonciulea A, Wang R, Althoff KN, Palella FJ, Lake J, Kingsley LA, Brown TT. An increased rate of fracture occurs a decade earlier in HIV+ compared with HIV− men. Aids. 2017;31(10):1435–43.CrossRefPubMedPubMedCentral
11.
Janssen MA, Koopmans PP, Kessels RP. Cognitive decline in relation to psychological wellbeing and HIV disease-and treatment characteristics in HIV-infected patients on cART: a one-year follow-up study. AIDS Behav. 2017;21(6):1728–34.CrossRefPubMed
12.
Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm DJ, Cooper DA. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. Aids. 1998;12(7):F51–8.CrossRefPubMed
13.
Hengel R, Watts N, Lennox J. Benign symmetric lipomatosis associated with protease inhibitors. Lancet. 1997;350(9091):1596.CrossRefPubMed
14.
15.
Morse CG, Kovacs JA. Metabolic and skeletal complications of HIV infection: the price of success. JAMA. 2006;296(7):844–54.CrossRefPubMed
16.
Hadigan C, Meigs JB, Corcoran C, Rietschel P, Piecuch S, Basgoz N, Davis B, Sax P, Stanley T, Wilson PW. Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis. 2001;32(1):130–9.CrossRefPubMed
17.
Hadigan C, Meigs J, Rabe J, D’agostino R, Wilson P, Lipinska I, Tofler G, Grinspoon S. Increased PAI-1 and tPA antigen levels are reduced with metformin therapy in HIV-infected patients with fat redistribution and insulin resistance. J Clin Endocrinol Metab. 2001;86(2):939–43.CrossRefPubMed
18.
Leveille SG, Thapa S: Disability among persons aging with HIV/AIDS. In: HIV and Aging. Interdiscipl Top Gerontol Geriatr. Volume 42, edn.: Karger Publishers; 2017: 101–118.
19.
Stein JH, Klein MA, Bellehumeur JL, McBride PE, Wiebe DA, Otvos JD, Sosman JM. Use of human immunodeficiency virus-1 protease inhibitors is associated with atherogenic lipoprotein changes and endothelial dysfunction. Circulation. 2001;104(3):257–62.CrossRefPubMed
20.
Shankar SS, Dubé MP, Gorski JC, Klaunig JE, Steinberg HO. Indinavir impairs endothelial function in healthy HIV-negative men. Am Heart J. 2005;150(5):933. e931–7.CrossRef
21.
Mayne ES, George JA. Mortal allies: human immunodeficiency virus and noncommunicable diseases. Curr Opin HIV AIDS. 2017;12(2):148–56.CrossRefPubMed
22.
Gagnon M. Understanding the experience of reconstructive treatments from the perspective of people who suffer from facial lipoatrophy: a qualitative study. Int J Nurs Stud. 2012;49(5):539–48.CrossRefPubMed
23.
Van der Valk M, Gisolf E, Reiss P, Wit F, Japour A, Weverling G, Danner S, Group PS. Increased risk of lipodystrophy when nucleoside analogue reverse transcriptase inhibitors are included with protease inhibitors in the treatment of HIV-1 infection. Aids. 2001;15(7):847–55.CrossRefPubMed
24.
Behrens G, Dejam A, Schmidt H, Balks H-J, Brabant G, Körner T, Stoll M, Schmidt RE. Impaired glucose tolerance, beta cell function and lipid metabolism in HIV patients under treatment with protease inhibitors. Aids. 1999;13(10):F63–70.CrossRefPubMed
25.
Non LR, Escota GV, Powderly WG. HIV and its relationship to insulin resistance and lipid abnormalities. Transl Res. 2017;183:41–56.CrossRefPubMed
26.
Guaraldi G, Stentarelli C, Zona S, Santoro A, Beghetto B, Carli F, Orlando G, Franceschetto A, Casolo A, Mussini C. The natural history of HIV-associated lipodystrophy in the changing scenario of HIV infection. HIV Med. 2014;15(10):587–94.PubMed
27.
Sacilotto LB, Pereira PCM, Manechini JPV, Papini SJ. Body composition and metabolic syndrome components on lipodystrophy different subtypes associated with HIV. J Nutr Metab. 2017;2017:8260867.CrossRefPubMedPubMedCentral
28.
Alves TC, de Moraes C, dos Santos AP, Venturini ACR, de Carvalho Santana R, Navarro AM, Machado DRL. Chance aumentada de síndrome metabólica em mulhe-res vivendo com HIV/AIDS e Síndrome da Lipodistrofia. Medicina (Ribeirão Preto Online). 2016;49(5):421–8.CrossRef
29.
Gomes AR, Souteiro P, Silva CG, Sousa-Pinto B, Almeida F, Sarmento A, Carvalho D, Freitas P. Prevalence of testosterone deficiency in HIV-infected men under antiretroviral therapy. BMC Infect Dis. 2016;16(1):628.CrossRefPubMedPubMedCentral
30.
Nansseu JR, Bigna JJ. Antiretroviral therapy related adverse effects: can sub-Saharan Africa cope with the new "test and treat" policy of the World Health Organization? Infect Dis Poverty. 2017;6(1):24.CrossRefPubMedPubMedCentral
31.
Sutinen J, Yki-Järvinen H. Increased resting energy expenditure, fat oxidation, and food intake in patients with highly active antiretroviral therapy-associated lipodystrophy. Am J Physiol Endocrinol Metab. 2007;292(3):E687–92.CrossRefPubMed
32.
Ramos RL, Armán JA, Galeano NA, Hernández AM, Gómez JG, Molinero JG. Dual energy X-ray absorptimetry: fundamentals, methodology, and clinical applications. Radiología (English Edition). 2012;54(5):410–23.CrossRef
33.
Bonnet E, Delpierre C, Sommet A, Marion-Latard F, Herve R, Aquilina C, Labau E, Obadia M, Marchou B, Massip P. Total body composition by DXA of 241 HIV-negative men and 162 HIV-infected men: proposal of reference values for defining lipodystrophy. J Clin Densitom. 2005;8(3):287–92.CrossRefPubMed
34.
Freitas P, Santos AC, Carvalho D, Pereira J, Marques R, Martinez E, Sarmento A, Medina JL. Fat mass ratio: an objective tool to define lipodystrophy in HIV-infected patients under antiretroviral therapy. J Clin Densitom. 2010;13(2):197–203.CrossRefPubMed
35.
Beraldo R, Vassimon H, Aragon D, Navarro A, de Paula FA, Foss-Freitas M. Proposed ratios and cutoffs for the assessment of lipodystrophy in HIV-seropositive individuals. Eur J Clin Nutr. 2015;69(2):274–8.CrossRefPubMed
36.
Alencastro PR, Barcellos NT, Wolff FH, Ikeda ML, Schuelter-Trevisol F, Brandao AB, Fuchs SC. People living with HIV on ART have accurate perception of lipodystrophy signs: a cross-sectional study. BMC Res Notes. 2017;10(1):40.CrossRefPubMedPubMedCentral
37.
Florindo AA, Latorre Mdo R, Santos EC, Borelli A, Rocha Mde S, Segurado AA. Validation of methods for estimating HIV/AIDS patients’ body fat. Revista de saude publica. 2004;38(5):643–9.CrossRefPubMed
38.
Segatto AFM, Junior IFF, Santos VRD, Alves KC, Barbosa DA, P Filho AM, Monteiro HL. Indices of body fat distribution for assessment of lipodysthrophy in people living with HIV/AIDS. BMC Res Notes. 2012;5(1):543.CrossRefPubMedPubMedCentral
39.
Harrison GG, Buskirk E, Carter JL, Johnston F, Lohman T, Pollock M, Roche A, Wilmore J. Skinfold thicknesses and measurement technique. Anthropometric standardization reference manual. 1988;1988:55–80.
40.
Callaway CW, Chumlea W, Bouchard C, Himes J, Lohman T, Martin A, Mitchell C, Mueller W, Roche A, Seefeldt V. Circumferences. Anthropometric standardization reference manual. 1988;1988:39–54.
41.
Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr. 2000;72(3):796–803.CrossRefPubMed
42.
Matiegka J. The testing of physical efficiency. Am J Phys Anthropol. 1921;4(3):223–30.CrossRef
43.
Norton K, Olds T, Albernaz NMF. Antropométrica: um livro sobre medidas corporais para o esporte e cursos da área de saúde. In: Antropométrica: um livro sobre medidas corporais para o esporte e cursos da área de saúde. edn.: Artmed; 2005.
44.
Mialich MS, dos Santos AP, da Silva BR, de Paula FJA, Jordão AA, Navarro AM. Relationship between adiposity indices, lipodystrophy, and sarcopenia in HIV-positive individuals with and without lipodystrophy. J Clin Densitom. 2017;20(1):73–81.CrossRefPubMed
45.
Dube NM, Summers R, Tint KS, Mayayise G. A pharmacovigilance study of adults on highly active antiretroviral therapy, South Africa: 2007–2011. Pan Afr Med J. 2012;11:39.PubMedPubMedCentral
46.
Berkman ND, Dewalt DA, Pignone MP, Sheridan SL, Lohr KN, Lux L, Sutton SF, Swinson T, Bonito AJ. Literacy and health outcomes. Evid Rep Technol Assess (Summ). 2004;87:1–8.
47.
Dennis S, Williams A, Taggart J, Newall A, Denney-Wilson E, Zwar N, Shortus T, Harris MF. Which providers can bridge the health literacy gap in lifestyle risk factor modification education: a systematic review and narrative synthesis. BMC Fam Pract. 2012;13:44.CrossRefPubMedPubMedCentral
48.
El-Sadr W, Mullin C, Carr A, Gibert C, Rappoport C, Visnegarwala F, Grunfeld C, Raghavan S. Effects of HIV disease on lipid, glucose and insulin levels: results from a large antiretroviral-naïve cohort. HIV Med. 2005;6(2):114–21.CrossRefPubMed
49.
Martinez E, Mocroft A, Garcia-Viejo MA, Perez-Cuevas JB, Blanco JL, Mallolas J, Bianchi L, Conget I, Blanch J, Phillips A, et al. Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study. Lancet. 2001;357(9256):592–8.CrossRefPubMed
50.
Miller J, Carr A, Emery S, Law M, Mallal S, Baker D, Smith D, Kaldor J, Cooper DA. HIV lipodystrophy: prevalence, severity and correlates of risk in Australia. HIV Med. 2003;4(3):293–301.CrossRefPubMed
51.
Abrahams Z, Levitt N, Lesosky M, Maartens G, Dave J. Changes in body fat distribution on dual-energy X-ray absorptiometry in black south Africans starting first-line antiretroviral therapy. AIDS Patient Care STDs. 2016;30(10):455–62.CrossRefPubMed
52.
Scherzer R, Heymsfield SB, Lee D, Powderly WG, Tien PC, Bacchetti P, Shlipak MG, Grunfeld C. Decreased limb muscle and increased central adiposity are associated with 5-year all-cause mortality in HIV infection. Aids. 2011;25(11):1405–14.CrossRefPubMedPubMedCentral
53.
Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. N Engl J Med. 2005;352(1):48–62.CrossRefPubMed
54.
Filippini P, Scolastico C, Battaglia M, Nacca C, Coppola N, Rossi G, Pisapia R, Martini S, Imparato M, Sagnelli C, et al. Lipodystrophy and serum lipid abnormalities in HIV-positive sub-Saharan population on ART. J Infect. 2006;53(1):e29–33.CrossRefPubMed
55.
Andany N, Raboud JM, Walmsley S, Diong C, Rourke SB, Rueda S, Rachlis A, Wobeser W, MacArthur RD, Binder L. Ethnicity and gender differences in lipodystrophy of HIV-positive individuals taking antiretroviral therapy in Ontario, Canada. HIV Clin Trials. 2011;12(2):89–103.CrossRefPubMed
Metadata
Title
Lipodystrophy diagnosis in people living with HIV/AIDS: prediction and validation of sex-specific anthropometric models
Authors
André P. dos Santos
Anderson M. Navarro
Andiara Schwingel
Thiago C. Alves
Pedro P. Abdalla
Ana Claudia R. Venturini
Rodrigo C. de Santana
Dalmo R. L. Machado
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2018
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-018-5707-z

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