Guaraldi_EU_Infectious.qxp 25/1/08 10:03 am Page 60
HIV and AIDS
Figure 2: Evaluation of Body Image Perception, Depression and Facial Aesthetic Satisfaction
7 120 40 10
6
100 8
30
5
80 6
4 20
60 4
3
10
2
40 2
1 20 0 0
Pre-ABCD7 Post-ABCD7 Pre-ABCD8 Post-ABCD8 Pre-Beck Post-Beck Pre-VAS Post-VAS
Figure shows subjective variables 48 weeks after the end of surgery compared with baseline. All of the differences are statistically significant.
Body image (BI) perception measured using the assessment of body change and distress questionnaire (ABCD); depression using the Beck depression inventory (BDI); and facial aesthetic
satisfaction using the Visual Analogue Scale (VAS).
to 6.2+2.1 (p<0.0001); of BI satisfaction ABCD question seven from somatic disturbances, as well as a general factor of depression.
32
The BDI
3.8+1 to 3.1+1 (p<0.0001); and ABCD question eight from 70.7+16.7 takes approximately 10 minutes to complete. The higher the score, the
to 77.2+17.2 (p<0.0001). There was also an improvement of objective greater the status of depression. The total possible score ranges from
outcome in terms of the augmentation of the thickness of both cheeks: 0 to 63. Mild depression was defined by a value of the scale between
right cheek from 4.3+1.9 to 9.5+3mm (p<0.0001); left cheek from 4.4+2 9 and 17, moderate depression between 18 and 29 and severe depression
to 9.6+3.1mm (p<0.0001). Notwithstanding the fact that surgery was for values above 30. At follow-up the BDI scale revealed a significant
limited to the face, all patients reported BI improvement even though this improvement in the depression score for the overall cohort from 11.4+8.3
questionnaire has no specific questions or items referring to facial (corresponding to mild depression) to 9.4+7.8 (almost absent of
lipoatrophy. Apparently, facial surgery determined an improvement of depression) (p=0.001). Nevertheless, analysing the score in the single
whole-body aesthetic satisfaction and psycho-social life (social and sexual surgery group, only in the polylactic acid and polyacrylamide groups did
life, health perception, habits, affections and relationships). This positive the score change reach statistical significance: lipofilling from 10+8.3 to
effect was evident in the overall sample and the polylactic acid and 10.4+8.7 (p=ns); lipofilling and polylactic acid from 15.6+10.5 to
polyacrylamide groups, while it did not reach statistical significance in 12.7+12.1 (p=ns); polylactic acid from 10.7+7.4 to 8+6.5 (p=0.001); and
the lipofilling group. polyacrylamide from 11.8+8.5 to 9.6+8.1 (p=0.014) (see Figure 2).
What was most striking was the impact of surgery on depression assessed In conclusion, we think facial surgery is a necessary option for the
with Beck depression inventory (BDI).
31
This is a self-administered 21-item treatment of HIV-related lipoatrophy that should be considered as an
scale measuring supposed manifestations of depression. It includes factors integral part of the management of patients with HIV infection because
that reflect negative attitudes towards self, performance impairment and of the clinically relevant and enduring psychological benefits. ■
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