Body fat maldistribution among human immunodeficiency virus-infected patients attending care and treatment clinics in Dar es salaam municipal hospitals

Abstract

Long term side effects of HAART such as body fat mal-distribution have not been reported in Tanzania, since care and treatment began in 2004. Likewise perceptions and attitude of HIV/AIDS patients on treatment on their body fat mal-distribution has not been studied previously. A cross sectional study was therefore conducted to determine the prevalence and most common risk factors for body fat mal-distribution among human immunodeficiency virus (HIV)-infected patients in Dar es Salaam and to assess the perceptions and attitudes these patients have on body fat mal-distribution. A total of 466 adult patients were interviewed during the study. Mean age of the participants was 41.1 ± 9.8 years, with men being more aged (46.1 ± 10.8 years) than women (39.6 ± 8.9 years) p<0.0001. Bivariate analysis showed significant association between body fat mal-distribution and sex (p=0.03), age (p=0.003), the use of HAART (p=0.0001) and the types of HAART (stavudine and efavirenz based (p<0.0001). In multivariate analysis the most important determinants of lypodystrophy in this population were stavudine based therapy (OR, 27.0, 95% CI 11.87-19.11, p<0.0001), efavirenz based therapy (OR, 8.5, 95% CI 3.8-61.50, p<0.0001), nevirapine based therapy (OR, 8.8, 95% CI 3.07-25.53, p<0.0001) and age group 41-50 years (OR, 4.3, 95% CI 1.18-16.14, p=0.03). Among the participants with lipodystrophy 15.8% felt strongly that their current body outlook/image is worse compared to the way they looked before and 10.5% reported to dislike their mirror image. On average 24.2% avoided wearing clothing that shows their body, 15.5% of participants felt they cannot attend outdoor activities, or meet new people (13.7%) or attend events that will have new people (12.6%). Based on these findings, we conclude that; there are a significant proportion of HIV positive patients who are on treatment with HAART that had lipodystrophy and stavudine, efavirenz, and nevirapine based therapies and increasing age were important determinants of lipodystrophy in this population. Negative perceptions and attitudes regarding ones‟ own body was also evident in this study. We recommend that, more efforts are required to have guidelines for care of patients with long term complications of HAART in Tanzania.