Funk Etai, Brissett Anthony E, Friedman Craig D, Bressler Fred J
Bobby R. Alford Department of Otolaryngology/Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
Laryngoscope. 2007 Aug;117(8):1349-53. doi: 10.1097/MLG.0b013e318064e8ab.
HIV-associated lipodystrophy is considered a sequela of highly active antiretroviral treatment. We describe the characteristics, possible etiology, and pathophysiology of HIV-associated lipodystrophy and facial lipoatrophy and establish a validated grading scale for HIV-associated facial lipoatrophy using evidence-based techniques.
DESIGN/METHODS: A grading scale was designed based on the severity of each patient's facial lipoatrophy. Preoperative photographs of HIV-infected patients seeking treatment for facial lipoatrophy and control subjects were reviewed by physicians qualified in facial plastic surgery. With use of the devised grading scale, each patient was assigned a severity score. These scores were then compared for interrater variability, and the distribution of scores was analyzed.
Preoperative photographs of 39 HIV-infected individuals with facial lipoatrophy and 6 normal subjects were obtained and reviewed. All patients were males. A Cohen kappa of 0.73 was calculated, and there was a fairly equal distribution of all severity grades throughout the 39 patients.
HIV-associated facial lipoatrophy is a major stigma for HIV patients that can have dramatic effects on their self-esteem, social habits, and medication compliance. This current study introduces a validated evidence-based grading scale that can be implemented to categorize disease severity. Using this scale will hopefully generate improved treatment plans directed to each patient, which should produce enhanced postoperative results.
人类免疫缺陷病毒（HIV）相关脂肪代谢障碍被认为是高效抗逆转录病毒治疗的后遗症。我们描述了HIV相关脂肪代谢障碍和面部脂肪萎缩的特征、可能的病因及病理生理学，并运用循证技术建立了一个经过验证的HIV相关面部脂肪萎缩分级量表。
设计/方法：根据每位患者面部脂肪萎缩的严重程度设计了一个分级量表。由合格的面部整形医生对寻求面部脂肪萎缩治疗的HIV感染患者及对照受试者的术前照片进行评估。使用所设计的分级量表，为每位患者分配一个严重程度评分。然后比较这些评分的评分者间变异性，并分析评分分布情况。
获取并评估了39例有面部脂肪萎缩的HIV感染个体及6例正常受试者的术前照片。所有患者均为男性。计算得出的科恩kappa系数为0.73，在这39例患者中所有严重程度等级的分布较为均衡。
HIV相关面部脂肪萎缩是HIV患者的一个主要耻辱标志，会对他们的自尊、社交习惯及服药依从性产生巨大影响。本研究引入了一个经过验证的循证分级量表，可用于对疾病严重程度进行分类。使用该量表有望制定出针对每位患者的改进治疗方案，从而产生更好的术后效果。
