Lipodystrophy-related symptoms (LS) and perceived body distress (PBD) in HIV positive individuals over three months
D. Wantland1, K. Kirksey2, I. Corless3, Y. Cuca4, A. Webel5, J. Voss6, W. Holzemer7, M. Rivero8, C. Portillo4, P. Nicholas3, T. Lindgren9, M.J. Hamilton10, S. Human11, S. Willard12, E. Sefcik10, M. Rosa13, S. Moezzi14, E. Huang4, L. Robinson15, J. Arudo16, M. Maryland17, C. Bain4, J. Kemppainen18, L. Eller7
1Columbia University, School of Nursing, New York City, United States, 2SETON Family of Hospitals, Austin, United States, 3MGH Institute of Health Professions, Boston, United States, 4University of California, School of Nursing, San Francisco, United States, 5Case Western Reserve University, Cleveland, United States, 6University of Washington, School of Nursing, Seattle, United States, 7Rutgers University, College of Nursing, Newark, United States, 8University of Puerto Rico, San Juan, Puerto Rico, 9University of California, San Francisco, School of Nursing, San Francisco, United States, 10Texas A&M University - Corpus Christi, Corpus Christi, United States, 11University of South Africa, Pretoria, South Africa, 12Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States, 13Universidad del Turabo, Gurabo, Puerto Rico, 14University of Utah, Salt Lake City, United States, 15University of San Diego, San Diego, United States, 16Aga Khan University, Nairobi, Kenya, 17University of Illinois at Chicago, Chicago, United States, 18University of North Carolina at Wilmington, Wilmington, United States
Issues: HIV-related, fat distribution body changes for those taking ART are frequently reported. Prior cross-sectional research demonstrated that many individuals can reduce symptom frequency and lipodystrophy-related distress. This 337-person sub-analysis from an international, longitudinal RCT (n=775) examines associations of lipodystrophy symptoms with anxiety, depression, diarrhea, fatigue, nausea, and neuropathy, and differences in PBD between groups with varying numbers of reported symptoms over time.
Description: Using parametric and nonparametric repeated-measures statistics, we analyzed self-reported demographics, LS-related symptoms (Symptom Checklist for HIV SSC-HIV rev) and PBD ratings (AACTG body distress scale). Baseline LS occurrences for stomach area weight gain, skinny arms/legs, hump on back/neck/shoulders, and prominent leg veins were assessed for incremental differences in change over time in PBD.
Lessons learned: This 55%-male, 38%-female, 8%-transgender-cohort revealed between-group PBD score differences (Fdf1,4=6.0, p≤.001) with trajectory differences between the no-symptom group-(NS), three-symptom group-(TS), and four-symptom groups-(FS) that varied over time (xNS0=39.71/xNS3=39.22; vs. xTS0=48.54/xTS3=46.39; vs.xFS0=49.53/xFS3=51.55). LS-group differences included: Undetectable viral load-(X2=58.6, p≤.001)-greater in NS group; Having an AIDS diagnosis-(X2=15.8, p=.04); Ethnicity-Hispanic/White > Black/Other-(X2=94.3, p≤.001) and taking ART were more likely to report LS-(F=290.0, p≤.001). Of those with LS, 62% also reported depression-(X2=115.0, p≤.001); 62% fatigue-(X2=89.9, p≤.001); 50% anxiety-(X2=156.4, p≤.001); 43% diarrhea-(X2=141.3, p≤.001); 38% nausea-(X2=193.4, p≤.001) and 55% neuropathies-(X2=400.4, p≤.001).
Next steps: Many factors, taken together, improve understanding of the illness experience for HIV-related fat distribution body changes. Even with improved ART regimens, this cohort reported significant PBD with increased symptom reports for those taking ART with no drug class difference. The role of LS with psychosocial, neuropathy, diarrhea, and nausea impacts the ratings of PBD. Hispanic and white ethnicities and having an AIDS diagnosis increased LS reports. An undetectable viral load improved LS report. Together, these data support development of ethnically-targeted interventions that reduce symptom occurrence and progression to AIDS and promote viral load suppression.
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