HIV-associated lipodystrophy in South Africa: The impact on the patient and the impact on the plastic surgeon
Journal of Plastic, Reconstructive and Aesthetic Surgery
Department of Surgery, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa; Department of Internal Medicine, Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
SummaryBackground With 67% of the world's human immunodeficiency virus (HIV)-infected population existing in sub-Saharan Africa and recent access to highly active antiretroviral therapy (HAART), the demand for plastic surgical intervention in addressing lipodystrophy has expanded dramatically. We assessed the rate of lipodystrophy in a random clinic cohort, the demand for surgical correction and risk of treatment non-compliance. Method Questionnaire and database cross-sectional review of 554 patients over a 3-month period at the Themba Lethu Clinic, Johannesburg, South Africa. Results A total of 479 patients completed the questionnaire, 83% were female. Nearly 90% of patients were on, or had been on, stavudine (d4T). The prevalence of lipodystrophy was 11.7%. Nearly 5.9% of patients had considered stopping treatment due to the development of lipodystrophy; 47% would consider surgery to correct unwanted physical changes. Male patients were satisfied by the changes they noted in their physical features following treatment (pre-treatment satisfaction 38% vs. post-treatment satisfaction of 94%). Female patients had 6.5 times more breast hypertrophy-related symptoms than in their pre-treatment state. Conclusion We identify a prevalence of 11.7% of patients with HIV-associated lipodystrophy, of whom 5.9% would consider non-compliance on the basis of this side effect alone. The demand for surgical correction is significant and needs to be addressed. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
stavudine; adult; article; breast hypertrophy; cross-sectional study; female; HIV associated lipodystrophy; human; major clinical study; male; patient compliance; patient satisfaction; plastic surgery; priority journal; sex difference; South Africa; surgery; Adult; Antiretroviral Therapy, Highly Active; Cross-Sectional Studies; Female; Health Services Needs and Demand; HIV-Associated Lipodystrophy Syndrome; Humans; Male; Prevalence; Proportional Hazards Models; Questionnaires; Reconstructive Surgical Procedures; Risk Factors; South Africa