Breast hypertrophy and gynaecomastia in HIV-associated lipodystrophy, a problematic side-effect of life-saving antiretroviral therapy
Date
2014
Authors
Zinn, Richard Joseph
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Abstract
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); demand for plastic surgical intervention in addressing HIV-associated
lipodystrophy has expanded dramatically. This study assessed the prevalence of
lipodystrophy in a random clinic cohort, the demand for surgical correction, and risk of
treatment non-compliance
A questionnaire and database cross-sectional review of 554 patients was performed over a
three-month period at the Themba Lethu Clinic, Johannesburg, South Africa.
A total of 479 patients completed the questionnaire, 83% were female. Nearly 90% of
patients were currently being treated, or had been treated with stavudine (d4T). The
prevalence of lipodystrophy was 11.7%. Nearly 5.9% of patients had considered stopping
treatment due to changes in body morphology following the onset of HAART, 47% of
patients interviewed would consider surgery to correct unwanted physical changes
following treatment with HAART. Male patients were satisfied by physical changes in
their body habitus 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 pretreatment state.
This study identified a prevalence of 11.7% of patients with HIV-associated
lipodystrophy. A total of 3.8% of all patients would consider non-compliance on the basis
of this side effect alone. The demand for surgical correction is significant, extends beyond
patients diagnosed with HIV-associated lipodystrophy, and needs to be addressed.
Description
A research report submitted to the Faculty of Medicine, University of the
Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of
Medicine in the division of Plastic and Reconstructive Surgery.
Johannesburg 2014