Association between facial lipoatrophy and self-esteem in people living with HIV/AIDS on antiretroviral therapy in Brazil: A cross-sectional study

BACKGROUND: Facial lipoatrophy in people living with HIV/AIDS (PLWHA) may lead to body image dissatisfaction, social difficulties, and reduced self-esteem, potentially affecting adherence to antiretroviral therapy (ART). This study evaluated the influence of facial lipoatrophy on self-esteem in PLWHA. METHODS: Ninety-five adults with confirmed HIV diagnosis and on ART for at least six months completed the Sociodemographic and Clinical Health Characterization Form, Rosenberg Self-Esteem Scale, and Self-Perceived Body Changes Questionnaire. Facial Lipoatrophy Index (FLI) assessment was performed by physical examination. Statistical analyses included the Pearson chi-square, Kruskal-Wallis, and Student's t-test (p < 0.05). RESULTS: Participants were mostly men (77.9 %), homosexual (62.1 %), under 40 years (52.6 %), and caucasian (68.4 %). The most frequent ART regimen was an integrase inhibitor plus two nucleoside reverse transcriptase inhibitors (58.9 %). Severe facial lipoatrophy was significantly associated with zidovudine and efavirenz use, and mild cases with dolutegravir (p < 0.05). Most participants (76.8 %) reported body changes, mainly abdominal (71.2 %). The mean FLI was 2.15, and mean self-esteem score 31.98 ± 5.26; 67.4 % demonstrated high self-esteem. Caucasian participants had higher self-esteem (p < 0.05), but neither objective nor perceived facial fat loss significantly affected self-esteem (p > 0.05). CONCLUSION: Facial lipoatrophy did not significantly impact self-esteem among PLWHA. Overall, participants exhibited high self-esteem regardless of facial changes or ART regimen, suggesting resilience and effective psychological adaptation within this sample.