Agreement analysis of variables involved in lipodystrophy syndrome definition in HIV-infected patients

Lipodystrophy studies in HIV-infected patients have usually defined abnormalities in body fat by clinical evaluation and patient questionnaires. Despite the risk for bias with these subjective approaches, agreement analysis among the large number of variables employed was seldom performed.

To analyze consistency between the usual approaches for definition of abnormalities in body fat distribution.

We evaluated agreement between the clinical and questionnaire findings for abnormalities in body fat in an HIV patient population under antiretroviral treatment followed in our institution, using different criteria for definitions of body fat abnormalities within the same data set.

Kappa analysis for consistency and receiver-operator characteristic (ROC) curve analysis were performed.

Low levels of agreement between clinical and patient perspectives were observed. Only one combination of criteria showed adequate agreement results. The waist/hip ratio showed low levels of agreement with all other variables, and no clear discriminative point was observed by ROC curve analysis. The ratio between the trunk fat content and the leg fat content assessed by dual energy x-ray absorptiometry (DEXA) scan demonstrated better agreement and more clear discriminative values for both male and female patients.

Agreement analyses may help in the selection of the subjective variable methodology and in the inclusion of consistent and nonredundant objective measurements for diagnosis of abnormalities in body fat.