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HIV Lipodystrophy Scoring System

Purpose: To determine if an HIV infected patient has HIV lipodystrophy.

Description

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).


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Specialty

Objective

ICD-10