OBJECTIVES: Lipodystrophy may have a great impact on quality of life (QoL). Current HIV specific instruments do not measure this impact. We performed a cultural adaptation and psychometric validation in French of a new lipodystrophy specific instrument Assessment of Body Change and Distress (ABCD). METHODS: ABCD consists of three parts: signs of lipodystrophy (6 items), global satisfaction (1 item) and 20 QoL items. Items were generated in US. Our study consisted of two parts: 1) Cultural adaptation; 2) Psychometric validation in a survey in comparison with specific (MOS-HIV) and generic (SF-12) QoL questionnaires. RESULTS: The approach of French patients was to some extent different from US patients, and needed cultural adaptation of several concepts. A total of 155 HIV French outpatients (143 with lipodystrophy) from 2 Parisian hospitals and one general practice were included. Mean age was 43±10 yrs. Mean duration of HAART was 4.5 ± 1.7 yrs. Discriminant validity: QoL scores decreased according to the number of sites with lipodystrophy, ranging from 85 ± 16 (none) to 42 ± 10 (6 sites), p<0.001, and according to whether patients were thinking about plastic surgery or not, from 68 ± 20 (never) to 33 ± 13 (always), p<0.001. Internal consistency was high (Cronbach alpha =0.94). Factorial analysis yielded a 4-factor structure. Convergent validity: the highest correlations were between ABCD QoL and health distress and social dimensions of the MOS-HIV (r > 0.6) and with the mental component of the SF-12 (r = 0.65). CONCLUSIONS: The psychological and social distress related to the body changes must be measured in clinical trials, to make sure that life is not lengthened at the expense of its quality. ABCD questionnaire is a validated questionnaire which can now be used in French.