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Psychosocial adjustment to facial lipoatrophy in people with HIV
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Abstracts presented at the 7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 13-16 November 2005, Dublin, Ireland
CA O'Donovan, M Hourihan, J Petrak and M Murphy
Infection & Immunity, Barts and the London NHS Trust, London, UK
ABSTRACT 34
Antiviral Therapy 2005; 10:L24
Background: Lipoatrophy is a common side effect related to ARV medication in people with HIV and results in visible changes to facial appearance. There is little understanding of the effect of lipoatrophy on psychological and social functioning. The aims of this study are to assess mood, quality of life and self esteem in this population and investigate the role of attitude to appearance and perceived stigma-effect adjustment in facial lipoatrophy.
Objectives: To explore psychosocial adjustment in people with HIV-related facial lipoatrophy.
Method: Patients attending a lipoatrophy service in a London teaching hospital completed the following questionnaires at initial assessment: Facial Appearance
Questionnaire, Rosenberg Self Esteem Scale, Hospital Anxiety and Depression Scale (HADS) and MOS SF 36.
Results:
--Of the 35 participants, 34 were male and mean age was 44 years.
--Twenty-five (71%) had case/borderline anxiety and 17 (48%) case/borderline depression on the HADS.
--Self-esteem scores were low (mean=16.7 ±4) and correlated inversely with levels of anxiety (r=0.82).
--Thirty-four participants (97%) felt lipoatrophy affected their confidence and 30 subjects (85%) felt stigmatized and that their appearance was a marker of HIV infection.
--Participants had significant limitations in usual role activity and quality of life; 97% of participants felt that facial appearance affected their confidence, 85% of the respondents felt that their facial appearance was a marker of HIV and 25 (71%) had social anxiety related to their appearance.
--Patients also reported concern both about the success of polylactic treatment for their lipoatrophy (17 [50%]) and the durability of treatment effect (12 [60%]).
Conclusions: Patients attending a lipoatrophy clinic have high levels of anxiety and depression and quality of life and self esteem is lower than in other reports of chronic illnesses. There is a high level of concern about enforced disclosure of HIV status due to the visible nature of facial lipoatrophy and stigma related to HIV.
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