Objective: To investigate the diagnostic accuracy of ultrasound (US) to identify the severity of body fat changes due to HIV-related lipoatrophy (LA) by US grading scale (US GS. Methods: US diagnoses based on measurements of the thickness of subcutaneous fat at representative reference points (RPs) for LA were compared to clinical diagnoses based on the HIV Outpatient Study Grading Scale (HOPS-GS). A sample size of 115 patients was required for statistical power of 80%. Results: 73 males [HOPS-GS-0: 31.5%, 41.2%, and 50.5%; HOPS-GS-1 42.5%, 32.5%, and 29%, and HOPS-GS-2/3 26%, 26.2% and 20.5%, for facial, brachial, and crural RPs, respectively] and 42 females [HOPS-GS-0 26%, 43%, and 28.6%; HOPS-GS-1 38%, 38% and 33.3%; and HOPS-GS-2/3 36, 19% and 38.1%, for facial, brachial, and crural RPs, respectively] were recruited. Significant differences were found in US assessments for each corresponding HOPS-GS (p<.003–.0001). Diagnostic thresholds were identified for each degree of LA severity (US-GS 0 vs. US-GS 1 and US-GS2-3) for facial, brachial, and crural LA, with related sensitivity (range: 83–99%), specificity (range: 85–99%), positive predictive values (range: 73–98%) and negative predictive values (range: 82–98%). Compared with clinical LA diagnoses, US-GS correctly diagnosed 80.9% of cases (OR: 8.1; 95%CI: 2.8–23.5, p<.0001). US identified 33% of cases with initial LA (fat loss <1.5mm from diagnostic thresholds) not recognizable by the clinical assessments. Conclusions: US shows good diagnostic accuracy in the assessment of early HIV related LA. US-GS may be valuable in routine management of HIV outpatients to objectively assess lipoatrophic findings. Keywords: Lipodystrophy; Sonography; HIV; Lipoatrohy; Antiretrovirals.
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