[P-20] Lipoatrophy (LA) and lipohypertrophy (LH) are independently associated with depression and health-related quality-of-life (HRQOL); lipoatrophy is associated with adherence

9th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

19-21 July 2007, Sydney, Australia

LIPOATROPHY (LA) AND LIPOHYPERTROPHY (LH) ARE INDEPENDENTLY ASSOCIATED WITH DEPRESSION AND HEALTH-RELATED QUALITY-OF-LIFE (HRQOL); LIPOATROPHY IS ASSOCIATED WITH ADHERENCE

Antiviral Therapy 2007; 12(Suppl. 2):L32 (abstract no. P-20)

HM Crane¹, C Grunfeld², RD Harrington¹ and MM Kitahata¹
¹University of Washington, Seattle, WA, USA; ²University of California San Francisco, San Francisco, CA, USA

BACKGROUND: Studies of depression, adherence, and lipodystrophy have provided contradictory findings and not examined LA and LH separately. We examined the independent effect of LA/LH on depression, HRQOL, and adherence using two scoring methods for self-reported LA/LH.

METHODS: Cross-sectional study of 311 University of Washington HIV Cohort patients. Patients completed depression (PHQ-9), HRQOL (EQ-5D), adherence, drug/alcohol use and body morphology (FRAM) assessments. We scored FRAM using categories (none, mild LA, mild LH, moderate-to-severe LA or moderate-to-severe LH), and also continuous LA/LH scores. We used linear and ordinal logistic regression to examine the association between depression, HRQOL and adherence with LA/LH controlling for covariates.

RESULTS: In adjusted analyses, mean depression scores were highest among patients with moderate LA (15.8), intermediate among those with moderate LH (13.3), mild LA (10.3) and mild LH (11.2), and lowest among those without abnormalities (8.1) (P-values <0.003–0.05). In adjusted analyses using continuous LA/LH scores, each point worsening in LA was associated with a 0.4 point worsening in depression, and each point worsening in LH was associated with a 0.3 point worsening in depression (P-values<0.001). A change of ≥0.074 in HRQOL score is considered clinically important. Mean HRQOL scores were lower for patients with moderate LA (0.62, P=0.03), moderate LH (0.64, P=0.002), mild LA (0.70, P=0.005) and mild LH (0.69, P=0.001) than patients without LA/LH (0.8). When depression was also included, worse depression was significantly associated with poorer HRQOL and the association between LA/LH and HRQOL was no longer present. LA but not LH scores were associated with poorer adherence while controlling for demographic/clinical factors, depression, and HRQOL (P=0.02). Each point worsening in LA was associated with a 10% increase in risk for decreased adherence (OR 1.1, P=0.01). There was no association between adherence and LA/LH categories.

CONCLUSIONS: LA/LH are independently associated with poorer HRQOL, an effect that appears to be mediated through depression severity. LA but not LH is associated with poorer adherence independent of depression. Using combined or categorized LA/LH results in a loss of information that may have practical implications. In addition to potential long-term cardiovascular implications, LA/LH may impact clinical outcomes via depression and adherence.

Download PDF of this abstract.

2007-07-24
P-20

Copyright © 2007 - International Medical Press Ltd. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Medical Editor, International Medical Press, 36 St Mary-at-Hill, London EC3R 8DU, United Kingdom.