Psychometric properties of WHOQOL-BREF-THAI in patients with HIV/AIDS.

OBJECTIVE: To assess reliability and validity of the Thai abbreviated version of World Health Organization quality of life (WHOQOL-BREF-THAI) in HIV/AIDS patients. MATERIAL AND METHOD: The present study is descriptive research. Data were purposefully collected from 120 HIV/AIDS outpatients at Bamrasnaradura Infectious Disease Institute, Thailand, during September-December 2004. RESULTS: Cronbach's alpha ranged from 0.61 to 0.81 across domains. Exploratory factor analysis identified four major domains: physical, psychological, social and environmental domains, corresponding to the four WHOQOL-BREF domains. The four domain scores correlated positively with general health satisfaction and overall quality of life questions (all p < 0.01 except general health & social domain p < 0.05), and correlated negatively with the frequency and severity of HIV symptoms (all p < 0.01). The four domain scores discriminated between patients with higher and lower frequency and severity of HIV symptoms (all p < 0.01). CONCLUSION: The present study shows that WHOQOL-BREF THAI can be a good generic health-related quality of life instrument in HIV/AIDS patients.

Prevalence of lipodystrophy in Thai-HIV infected patients.

To determine the prevalence and clinical characteristics of lipodystrophy in HIV-infected Thai patients, a cross-sectional study was performed on 278 HIV-infected patients at Bamrasnaradura Infectious Disease Institute. Laboratory data related to lipid and glucose metabolism were obtained from both patients who self reported fat maldistribution or diagnosed by a physician. The history of antiretroviral treatment and HIV infection were recorded. Prevalence of lipodystrophy found in the present study was 17%. Lipodystrophy was reported mostly on the face, buttock, legs, arms, and abdomen respectively. Two-thirds of these patients had mixed syndromes of fat accumulation and fat wasting and the others had only fat wasting. Ninety-three percent of lipodystrophic patients had at least 1 abnormality in either lipid or glucose metabolism. Eighty-eight percent had dyslipidemia, 21% had impaired glucose tolerance, 30% had insulin resistance and 27% had diabetes mellitus. Lipodystrophic patients have a high rate of lipid and glucose metabolism abnormalities which are the major risk factors for cardiovascular events.

Improvement of fat redistribution, insulin resistance and hepatic fatty infiltration in HIV-associated lipodystrophy syndrome by pioglitazone: a case report.

HIV-associated lipodystrophy syndrome is a syndrome occurring in HIV-infected patients who were treated with highly-active antiretroviral therapy (HAART), especially regimen containing protease inhibitors. The syndrome consists of fat redistribution, with loss of subcutaneous fat and increase in visceral fat, and metabolic disturbances, including glucose intolerance or overt diabetes and dyslipidemia. No standard treatment has been established for this syndrome. Pioglitazone is an oral antidiabetic agent that acts primarily on adipose tissue to reduce insulin resistance. The authors report a 50-year old HIV-infected woman who developed HIV-associated lipodystrophy syndrome after 3 months of HAART. She had significant weight loss with obvious loss of subcutaneous fat, together with development of hypertension, diabetes and dyslipidemia. After treatment with 30 milligrams of pioglitazone daily, her body weight increased within the first month of treatment. Subcutaneous fat loss was restored. Improvement in glycemic and lipid control was also noted. CT scan of the abdomen revealed that fatty infiltration in the liver was markedly decreased. Visceral fat as assessed by CT scan had also decreased. Pioglitazone appeared to have beneficial effects in this patient.