The HIV Lipodystrophy Case Study Group developed a scoring system to identify patients with HIV lipodystrophy. The authors are from multiple institutions from around the world.
Parameters:
(1) gender
(2) age of the patient in years
(3) duration of HIV infection
(4) CDC category
(5) waist to hip circumference ratio
(6) HDL cholesterol (after 3 day regular diet, overnight fast, well hydrated)
(7) anion gap
(8) visceral to subcutaneous fat ratio (VAT to SAT) from CT scan at mid-L4 vertebral level
(9) trunk to limb fat ratio from DEXA scan
(10) percent fat in leg based on DEXA scan
Parameter |
Finding |
Points |
---|---|---|
gender |
male |
0 |
|
female |
22 |
age of the patient |
<= 40 years of age |
0 |
|
> 40 years of age |
7 |
duration of HIV infection |
<= 4 years |
0 |
|
> 4 years |
11 |
CDC category |
A |
0 |
|
B |
3 |
|
C |
7 |
waist to hip circumference ratio |
|
(ratio) * 29 |
HDL cholesterol in mmol/L |
|
(HDL cholesterol) * (-14) |
anion gap in mmol/L |
|
(anion gap in mmol/L) |
VAT to SAT ratio |
< 0.45 |
0 |
|
0.45 - 0.830 |
-2 |
|
0.831 - 1.59 |
3 |
|
> 1.59 |
13 |
trunk to limb fat ratio |
|
(ratio) * 5 |
leg fat |
>21.4% |
-16 |
|
14.5 - 21.4% |
-14 |
|
8.8 - 14.49% |
-8 |
|
< 8.8% |
0 |
waist to hip circumference ratio =
= (circumference of waist in cm) / (circumference of hips in cm)
VAT to SAT ratio =
= (area of intra-abdominal visceral fat on CT scan in square cm) / (area of subcutaneous extra-abdominal fat on CT scan in square cm)
trunk to limb fat ratio =
= (trunk fat in kg) / (limb fat in kg)
total score =
= SUM(points for all 10 parameters) - 43
Interpretation:
• minimum score: my estimate is around -44
• A score < 0 indicates no lipodystrophy is present.
• A score >= 0 indicates lipodystrophy is present.
Performance:
• Using a cutoff >= 0 had a sensitivity of 79% and specificity of 80% (from Table 7, page 733).
Purpose: To determine if an HIV infected patient has HIV lipodystrophy.
Specialty: Endocrinology, Clinical Laboratory, Infectious Diseases
Objective: clinical diagnosis, including family history for genetics, criteria for diagnosis, severity, prognosis, stage
ICD-10: E88.1,