Fat Mass Ratio in Brazilian HIV-infected Patients Under Antiretroviral Therapy and Its Relationship With Anthropometric Measurents.

INTRODUCTION: Human immunodeficiency virus-related lipodystrophy is characterized by a variety of phenotypes and metabolic changes; however, consensus has not yet been reached on its diagnostic criteria. Different cutoff values for fat mass ratio have been proposed for this specific population as an objective diagnostic criterion for lipodystrophy. This study aimed to establish sex-specific reference values for fat mass ratio and to correlate them with anthropometric measurements for the diagnosis of human immunodeficiency virus-related lipodystrophy. METHODOLOGY: A cross-sectional study was performed on 189 human immunodeficiency virus-infected patients under antiretroviral therapy. Anthropometric measurements were evaluated, and body composition was determined using dual-energy X-ray absorptiometry. Fat mass ratio was calculated as the ratio of the percentage of the trunk fat mass and the percentage of the lower limb fat mass. RESULTS: One hundred and thirty-two patients (69%) presented lipodystrophy by objective criteria. In men, the cutoff for the fat mass ratio was 1.55 (area under the receiver operating characteristic curve: 0.73 [95% confidence interval: 0.62-0.83], p = 0.000008), with a sensitivity of 62.5%, a specificity of 70.5%, a positive predictive value of 77.8%, and a negative predictive value of 53.4%. In women, the cutoff for the fat mass ratio was 0.959 (area under the receiver operating characteristic curve: 0.70 [95% confidence interval: 0.56-0.85], p = 0.03), with a sensitivity of 83.60%, a specificity of 61.5%, a positive predictive value of 90.2%, and a negative predictive value of 47.1%. Fat mass ratio was positively correlated with waist circumference (men: r = 0.246, p = 0.019; women: r = 0.302, p = 0.014) and neck circumference (men: r = 0.304, p = 0.004; women: r = 0.366, p = 0.003) in both sexes; and body mass index (r = 0.288, p = 0.006) and waist-hip ratio (r = 0.288, p = 0.006) in men. CONCLUSION: The fat mass ratio evaluated using dual-energy X-ray absorptiometry with the sex-specific cutoffs is an objective tool to define human immunodeficiency virus-related lipodystrophy.

Discordance between body mass index and anthropometric measurements among HIV-1-infected patients on antiretroviral therapy and with lipoatrophy/lipohypertrophy syndrome.

INTRODUCTION: Highly Active Antiretroviral Therapy (HAART) has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS) and its associated risks. OBJECTIVE: This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS. METHODS: An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP). The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI) and percentage of body fat (% BF). The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR) and waist circumference (WC). RESULTS: The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF) in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively). In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726). The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005) and (p = 0.011). CONCLUSIONS: Anthropometric measurements were useful in the confirmation of the prevalence of LLS. BMI alone does not appear to be a good parameter for assessing the nutritional status of HIV-infected patients on HAART and with LLS. Other anthropometric measurements are needed to evaluate patients with the lipoatrophy/lipohypertrophy syndrome.

Discordance beteeen body mass index and anthropmetric measurements among hiv-11-infected patients on antiretroviral therapy and with lipoatrophy/lipohypertrophy syndrome / Discordância entre o índice de massa corporal e outras medidas antropométricas em pacientes infectados pelo HIV com a síndrome de lipoatrofia/lipohipertrofia em uso de medicação antirretroviral

Introduction: Highly Active Antiretroviral Therapy (HAART) has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS) and its associated risks. Objective: This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS. Methods: An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP). The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI) and percentage of body fat (% BF). The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR) and waist circumference (WC). Results: The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF) in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively). In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726). The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005) and (p = 0.011). ...

Objetivos: A terapia antirretroviral altamente ativa (HAART) tem melhorado e aumentado a vida de milhares de pessoas que vivem com a infecção pelo HIV/AIDS em todo o mundo. No entanto, este tratamento pode levar ao desenvolvimento da síndrome da lipodistrofia (LDS). Este estudo foi desenvolvido para avaliar a prevalência de auto-relato de LDS, perfil nutricional e medidas antropométricas de pacientes com HIV/AIDS. Métodos: Estudo observacional de 227 pacientes adultos, divididos em: Grupo 1: 92 pacientes em HAART e com LDS; Grupo 2: 70 pacientes em tratamento com HAART e sem LDS e Grupo 3: 65 pacientes que não tomam HAART. O estado nutricional foi avaliado pelo índice de massa corporal (IMC) e o percentual de gordura corporal (%GC) por meio de medidas antropométricas. Resultados: A prevalência de auto-relato de LDS foi de 44% entre as mulheres e 39% entre os homens. DC do tríceps (PCT) apresentou-se mais elevada no grupo HAART e LDS (homens p < 0,001; mulheres p < 0,007) em comparação com aqueles sem HAART, respectivamente. IMC revelou excesso de peso para a maioria dos indivíduos. Conclusões: As medidas antropométricas foram úteis para confirmar a prevalência de auto-relato da síndrome da lipodistrofia. A avaliação das dobras dos braços e pernas revelou-se um bom método para avaliação antropométrica de lipoatrofia de membro, independentemente do sexo. Estes resultados permitiram o estabelecimento de estratégias para o diagnóstico precoce da LDS na prática clínica, em pessoas vivendo com HIV / AIDS. .

Proposed ratios and cutoffs for the assessment of lipodystrophy in HIV-seropositive individuals.

OBJECTIVES: To propose objective ratios using anthropometry and dual-energy X-ray absorptiometry (DXA) and to suggest cutoff points for them in order to classify lipodystrophy in male patients. METHODS: It is a cross-sectional study. DXA was applied and anthropometric measurements were performed in 100 men on highly active antiretroviral therapy. Receiver operating characteristic curves were used to propose cutoffs. Individuals were divided in without (lipo-) or with (lipo+) lipodystrophy and their metabolic parameters were compared. RESULTS: The following ratios were proposed: fat mass ratio by DXA (FMR), waist thigh ratio (WTR), waist calf ratio (WCR), and arm to trunk ratio (ATR). The best cutoffs observed for FMR, WTR and ATR were 1.26, 1.74 and 2.08, respectively. Using the proposed cutoff for FMR, we observed worse metabolic profile, with increased tryglicerides, fasting serum glucose and more hypercholesterolemia in the lipo+ group. WTR and ATR showed a significant correlation with FMR. CONCLUSIONS: Anthropometric ratios (WTR/ATR) and FMR can be used to aid the diagnosis of lipodystrophy in order to contribute to a more accurate and earlier diagnosis permitting intervention and even preventing metabolic disturbances.

Prevalence of lipodystrophy and risk factors for dyslipidemia in HIV-infected children in Brazil

The aim of present study was to describe the frequency of lipodystrophy syndrome associated with HIV (LSHIV) and factors associated with dyslipidemia in Brazilian HIV infected children. HIV infected children on antiretroviral treatment were evaluated (nutritional assessment, physical examination, and laboratory tests) in this cross-sectional study. Univariate analysis was performed using Mann-Whitney test or Fisher's exact test followed by logistic regression analysis. Presence of dyslipidemia (fasting cholesterol >200 mg/dl or triglycerides >130 mg/dl) was the dependent variable. 90 children were enrolled. The mean age was 10.6 years (3-16 years), and 52 (58%) were female. LSHIV was detected in 46 children (51%). Factors independently associated with dyslipidemia were: low intake of vegetables/fruits (OR = 3.47, 95%CI = 1.04-11.55), current use of lopinavir/ritonavir (OR = 2.91, 95%CI = 1.11-7.67). In conclusion, LSHIV was frequently observed; inadequate dietary intake of sugars and fats, as well as current use of lopinavir/ritonavir was associated with dyslipidemia.

Prevalence of lipodystrophy and risk factors for dyslipidemia in HIV-infected children in Brazil.

The aim of present study was to describe the frequency of lipodystrophy syndrome associated with HIV (LSHIV) and factors associated with dyslipidemia in Brazilian HIV infected children. HIV infected children on antiretroviral treatment were evaluated (nutritional assessment, physical examination, and laboratory tests) in this cross-sectional study. Univariate analysis was performed using Mann-Whitney test or Fisher's exact test followed by logistic regression analysis. Presence of dyslipidemia (fasting cholesterol >200mg/dl or triglycerides >130mg/dl) was the dependent variable. 90 children were enrolled. The mean age was 10.6 years (3-16 years), and 52 (58%) were female. LSHIV was detected in 46 children (51%). Factors independently associated with dyslipidemia were: low intake of vegetables/fruits (OR=3.47, 95%CI=1.04-11.55), current use of lopinavir/ritonavir (OR=2.91, 95%CI=1.11-7.67). In conclusion, LSHIV was frequently observed; inadequate dietary intake of sugars and fats, as well as current use of lopinavir/ritonavir was associated with dyslipidemia.

Body composition and lipodystrophy in prepubertal HIV-infected children

OBJECTIVE: To identify lipodystrophy in prepubertal HIV-infected children using anthropometric parameters and body composition assessment. METHODS: Cross-sectional study including 40 prepubertal HIV-infected children of both genders seen at the Care Center of the Division of Pediatric Infectious Diseases - Universidade Federal de São Paulo, São Paulo city, Brazil, was carried out from August to December 2008. Age, clinical and immunological status, prophylaxis, transmission and highly active antiretroviral therapy were recorded. Body mass index z-score and height-for-age z-score were calculated to characterize the nutritional status. Circumferences were measured with flexible tape and skinfolds were assessed by an adipometry. Fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Presence of clinical signs of lipodystrophy was assessed by a trained clinician. Data were analyzed using SPSS 12.0 software. RESULTS: The mean age and standard deviation were 9.8 (1.2) years, 50% were girls and 82.5% children from B and C categories. Clinical lipodystrophy and dislypidemia were present in 27.5% and 70%, respectively. The trunk to arm ratio and the limb to trunk ratio had positive association with lipodystrophy. Patients with lipodystrophy had short stature, higher triglycerides values and lower HDL-cholesterol. CONCLUSION: The ratios obtained by skinfolds and dual-energy X-ray absorptiometry measurements can be considered as indicators of preclinical lipodystrophy. The cutoff points have not been determined yet; however, continuous assessment may be useful to identify early body composition changes.

Body composition and lipodystrophy in prepubertal HIV-infected children.

OBJECTIVE: To identify lipodystrophy in prepubertal HIV-infected children using anthropometric parameters and body composition assessment. METHODS: Cross-sectional study including 40 prepubertal HIV-infected children of both genders seen at the Care Center of the Division of Pediatric Infectious Diseases - Universidade Federal de São Paulo, São Paulo city, Brazil, was carried out from August to December 2008. Age, clinical and immunological status, prophylaxis, transmission and highly active antiretroviral therapy were recorded. Body mass index z-score and height-for-age z-score were calculated to characterize the nutritional status. Circumferences were measured with flexible tape and skinfolds were assessed by an adipometry. Fat mass and lean mass were determined by dual-energy X-ray absorptiometry. Presence of clinical signs of lipodystrophy was assessed by a trained clinician. Data were analyzed using SPSS 12.0 software. RESULTS: The mean age and standard deviation were 9.8 (1.2) years, 50% were girls and 82.5% children from B and C categories. Clinical lipodystrophy and dislypidemia were present in 27.5% and 70%, respectively. The trunk to arm ratio and the limb to trunk ratio had positive association with lipodystrophy. Patients with lipodystrophy had short stature, higher triglycerides values and lower HDL-cholesterol. CONCLUSION: The ratios obtained by skinfolds and dual-energy X-ray absorptiometry measurements can be considered as indicators of preclinical lipodystrophy. The cutoff points have not been determined yet; however, continuous assessment may be useful to identify early body composition changes.

Lipodistrofia en pacientes con VIH/SIDA: Estudio descriptivo, prospectivo, transversal sobre la incidencia de lipodistrofia en pacientes pediátricos con VIH/SIDA que reciben terapia antirretroviral en clínica de atención integral de VIH/SIDA, Hospital Regional de Occidente San Juan de Dios durante mayo a junio de 2011 / ILipodistrofia in patients with HIV / AIDS: a descriptive, prospective, cross-sectional study on the prevalence of lipodystrophy in pediatric patients with HIV / AIDS receiving antiretroviral therapy clinic comprehensive HIV / AIDS, Western Regional Hospital San Juan de Dios in may june 2011

El uso de la terapia antirretroviral ha mejorado la calidad de vida de los niños. El inicio de estos fármacos ha sido muy positivo en la lucha contra la pandemia de VIH/sida, hasta el momento es la única con la que se cuenta para el control de la infección pero la introducción en el organismo de estos fármacos con actividad enzimática supone en muchos casos una reacción adversa al propio cuerpo. Así se describen numerosos efectos secundarios asociados al uso de estos medicamentos...

HIV-Associated facial lipoatrophy: from the advent to current knowledge.

The advent of AIDS has brought new challenges to Dermatology. Antiretroviral therapy dramatically changed the morbidity and mortality associated with HIV / AIDS, but contributed to the emergence of other new situations that require adequate approach by the dermatologist. The HIV / AIDS Associated Lipodystrophy Syndrome is multifactorial in origin, but it is strongly associated with the use of antiretroviral drugs. It includes changes in body fat distribution, with or without metabolic changes. The loss of facial fat, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome. This condition, often revealing of the disease, brought back the stigma of AIDS. It is necessary that the specialists working with patients with HIV / AIDS identify these changes and seek treatment options, amongst which stands out the implant with polymethylmethacrylate, which is available for the treatment of HIV / AIDS facial lipoatrophy in the Brazilian Public Health System.

Facial lipodystrophy in an HIV-positive patient using an orthodontic appliance.

The aim of this article was to relate the clinical case of an HIV-positive orthodontic patient who reported that her cheeks had been hurting since treatment began. We started with the data collected in anamnesis and by contact with the patient's physician, and a diagnosis of facial lipodystrophy as a result of the use of retroviral drugs was reached. The patient was referred to a dermatologist for treatment of the facial lipodystrophy.

Lipoatrofia facial associada ao HIV/AIDS: do advento aosconhecimentos atuais / HIV-Associated facial lipoatrophy: from the advent to current knowledge

O advento da AIDS trouxe novos desafios para a Dermatologia. A terapia antirretroviral mudou drasticamente a morbimortalidade associada à infecção pelo HIV/AIDS, mas contribuiu para o surgimento de outras novas situações que exigem abordagem adequada do dermatologista. A Síndrome Lipodistrófica Associada ao HIV/AIDS tem origem multifatorial, mas está fortemente associada ao uso dos antirretrovirais. Compreende alterações na distribuição da gordura corporal, acompanhada ou não de alterações metabólicas. A perda da gordura da face, chamada lipoatrofia facial, é dos sinais mais estigmatizantes da síndrome. Esta condição, muitas vezes reveladora da doença, trouxe de volta o estigma da AIDS. É necessário que os especialistas que atuam com pacientes com HIV/AIDS identifiquem estas alterações e busquem opções de tratamento, dentre as quais se destaca o implante com polimetilmetacrilato, que é disponibilizado para tratamento da lipoatrofia facial associada ao HIV/AIDS no Sistema Único de Saúde.

The advent of AIDS has brought new challenges to Dermatology. Antiretroviral therapy dramatically changed the morbidity and mortality associated with HIV / AIDS, but contributed to the emergence of other new situations that require adequate approach by the dermatologist. The HIV / AIDS Associated Lipodystrophy Syndrome is multifactorial in origin, but it is strongly associated with the use of antiretroviral drugs. It includes changes in body fat distribution, with or without metabolic changes. The loss of facial fat, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome. This condition, often revealing of the disease, brought back the stigma of AIDS. It is necessary that the specialists working with patients with HIV / AIDS identify these changes and seek treatment options, amongst which stands out the implant with polymethylmethacrylate, which is available for the treatment of HIV / AIDS facial lipoatrophy in the Brazilian Public Health System.

Lipodystrophy in HIV/AIDS patients with different levels of physical activity while on antiretroviral therapy.

INTRODUCTION: Lipodystrophy is related to the use of highly active antiretroviral therapy (HAART) and can cause aesthetic stigma and increase the risk of developing cardiovascular diseases. Physical activity may be a valid alternative for the treatment and prevention of lipodystrophy. However, few studies address this issue. The objective of this study was to assess lipodystrophy related to highly active antiretroviral therapy in HIV/AIDS patients with different physical activity habits. METHODS: The sample was composed of 42 HIV/AIDS patients taking HAART medication who were visiting the Counseling and Testing Center (CTC) in Presidente Prudente. The level of physical activity was obtained using the International Physical Activity Questionnaire (IPAQ); lipodystrophy was diagnosed using a self-report questionnaire that was administered to the patient and then followed up by medical confirmation. The percentage of trunk fat was estimated by dual X-Ray absorptiometry (DEXA). Information about sex, age, length of HAART treatment, CD4+ T lymphocyte count (CD4) and viral load was also collected. RESULTS: A higher prevalence of lipodystrophy was observed in the sedentary group when compared to the physically active group, which indicates that physical activity may be a protective factor in relation to the occurrence of lipodystrophy. The group that had a higher CD4 had a higher proportion of lipodystrophy and a higher proportion of younger and physically active individuals. The patients with lipodystrophy had a higher percentage of trunk fat and were more sedentary than active individuals. CONCLUSIONS: A physically active lifestyle has a protective effect against the occurrence of lipodystrophy related to HAART.

Lipodystrophy in HIV/AIDS patients with different levels of physical activity while on antiretroviral therapy / Lipodistrofia em pacientes com HIV/AIDS com diferentes hábitos de atividade física, em uso de terapia antirretroviral

INTRODUCTION: Lipodystrophy is related to the use of highly active antiretroviral therapy (HAART) and can cause aesthetic stigma and increase the risk of developing cardiovascular diseases. Physical activity may be a valid alternative for the treatment and prevention of lipodystrophy. However, few studies address this issue. The objective of this study was to assess lipodystrophy related to highly active antiretroviral therapy in HIV/AIDS patients with different physical activity habits. METHODS: The sample was composed of 42 HIV/AIDS patients taking HAART medication who were visiting the Counseling and Testing Center (CTC) in Presidente Prudente. The level of physical activity was obtained using the International Physical Activity Questionnaire (IPAQ); lipodystrophy was diagnosed using a self-report questionnaire that was administered to the patient and then followed up by medical confirmation. The percentage of trunk fat was estimated by dual X-Ray absorptiometry (DEXA). Information about sex, age, length of HAART treatment, CD4+ T lymphocyte count (CD4) and viral load was also collected. RESULTS: A higher prevalence of lipodystrophy was observed in the sedentary group when compared to the physically active group, which indicates that physical activity may be a protective factor in relation to the occurrence of lipodystrophy. The group that had a higher CD4 had a higher proportion of lipodystrophy and a higher proportion of younger and physically active individuals. The patients with lipodystrophy had a higher percentage of trunk fat and were more sedentary than active individuals. CONCLUSIONS: A physically active lifestyle has a protective effect against the occurrence of lipodystrophy related to HAART.

INTRODUÇÃO: A lipodistrofia relacionada ao uso de terapia antirretroviral (TARV) pode causar estigma estético e elevar o risco de doenças cardiovasculares. A atividade física pode ser uma alternativa válida para o tratamento e prevenção da lipodistrofia. Entretanto, poucos estudos tratam dessa temática. O objetivo deste estudo foi verificar a ocorrência de lipodistrofia relacionada ao uso de TARV em portadores de HIV/AIDS, com diferentes hábitos de atividades físicas. MÉTODOS: A casuística foi formada por 42 portadores de HIV em uso de TARV, do Centro de Testagem e Aconselhamento de Presidente Prudente. Para obtenção do nível de atividade física aplicou-se o Questionário Internacional de Atividade Física (IPAQ); a lipodistrofia foi diagnosticada pelo autorrelato do paciente e a confirmação médica. O percentual de gordura de tronco foi estimado pela absortometria por raio-X de dupla energia (DEXA). Foram coletados também dados referentes a sexo, idade, tempo de uso de TARV, valores de CD4 e carga viral. RESULTADOS: Verificou-se maior ocorrência de lipodistrofia no grupo sedentário quando comparado ao ativo, além de fator protetor da prática da atividade física em relação à ocorrência da lipodistrofia. O grupo com valores mais elevados de CD4 também apresentou maior proporção de sujeitos com lipodistrofia, além de maior proporção de ativos e de indivíduos com menor faixa etária. Os acometidos pela lipodistrofia apresentaram maiores valores de percentual de gordura de tronco, bem como, os sedentários em relação aos ativos. CONCLUSÕES: O estilo de vida fisicamente ativa resultou em efeito protetor para ocorrência da lipodistrofia relacionada ao uso da TARV.

Implicações do diagnóstico da lipodistrofia no paciente soropositivo para HIV

Introdução: As alterações metabólicas e morfológicas, denominadas de Síndrome Lipodistrófica do HIV (SLHIV), oriundas da infecção pelo HIV e da adesão a Highly Active Antiretroviral Therapy (HAART), atualmente na literatura carecem de um instrumento objetivo que possa efetuar seu diagnóstico, em virtude de uma não padronização precisa de critérios metodológicos. Objetivo: Revisar as dificuldades e os métodos utilizados para o diagnóstico da SLHIV. Metodologia: Revisão de literatura utilizando o banco de dados “Pubmed” e “Google acadêmico”. Resultados: A grande dificuldade para o diagnóstico da SLHIV diante do método subjetivo consiste em estabelecer o quanto considerar como significante a redução e/ou acúmulo de gordura, além de necessário ser abordadas variáveis bioquímicas e elementos da história pregressa do paciente. Conclusão: Diante das falhas da análise subjetiva e do alto custo das técnicas utilizadas para verificar a morfodistrofia, a proposição de um método acessível, acurado e reprodutível para diagnóstico da SLHIV é necessário .

Lipodystrophy in children and adolescents with acquired immunodeficiency syndrome and its relationship with the antiretroviral therapy employed.

OBJECTIVE: To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS: This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS: All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80% were on three drugs in combination (highly active therapy) and 30% were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60% of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7%; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS: The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.

Lipodistrofia em crianças e adolescentes com síndrome da imunodeficiência adquirida e sua relação com a terapia antirretroviral empregada / Lipodystrophy in children and adolescents with acquired immunodeficiency syndrome and its relationship with the antiretroviral therapy employed

OBJETIVO: Avaliar a presença de lipodistrofia clínica em crianças com síndrome da imunodeficiência adquirida e relacioná-la com o esquema antirretroviral utilizado, alterações do perfil lipídico e resistência insulínica. MÉTODOS: Por meio de estudo transversal, foram avaliadas 30 crianças e adolescentes (mediana de idade = 9,1 anos) com síndrome da imunodeficiência adquirida, no período entre 2004 e 2005. As avaliações clínico-laboratoriais incluíram: classificação da infecção pelo HIV, medidas antropométricas (peso e estatura), glicemia e insulina séricas e perfil lipídico (LDL-c, HDL-c, triglicérides). A lipodistrofia foi definida por parâmetros clínicos. O teste do qui-quadrado foi utilizado na análise estatística. RESULTADOS: Todos os pacientes recebiam terapia antirretroviral regularmente (mediana de tempo de uso = 28,4 meses), 80 por cento utilizavam três drogas em associação (terapia fortemente ativa) e 30 por cento usavam inibidores de protease. Lipodistrofia e dislipidemia foram observadas em 53,3 e 60 por cento dos pacientes, respectivamente. Crianças que utilizavam terapia fortemente ativa com inibidor de protease apresentaram maior percentual de lipodistrofia mista, com diferença estatisticamente significante em relação ao grupo com terapia fortemente ativa sem inibidor de protease e ao grupo sem terapia fortemente ativa (44,4 versus 16,7 por cento; p = 0,004). Não se observou diferença estatisticamente significante entre presença de lipodistrofia e gênero, idade (> 10 anos), alterações do perfil lipídico e resistência insulínica. CONCLUSÕES: A elevada prevalência de dislipidemia e lipodistrofia verificada nas crianças com síndrome da imunodeficiência adquirida, mostrando relação com o esquema antirretroviral empregado, pode significar um risco elevado para o desenvolvimento futuro de complicações, especialmente as cardiovasculares.

OBJECTIVE: To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS: This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS: All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80 percent were on three drugs in combination (highly active therapy) and 30 percent were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60 percent of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7 percent; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS: The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.

Clinical and biochemical evaluation of HIV-related lipodystrophy in an ambulatory population from the Hospital Universitário Cassiano Antonio de Morais, Vitória, ES, Brazil.

We designed a retrospective cohort study to identify factors associated with HIV-1 related lipodystrophy at a tertiary HIV-care center in Vitória, ES, Brazil. Inclusion criteria were documented HIV diagnosis, anti-retroviral therapy and age above 17 years. Highly active antiretroviral therapy (HAART) was initially the exposure variable, but a second analysis was also performed, as a nested case-control, based on the presence or absence of lipodystrophy. Use of protease inhibitors (PI) was associated with an increase in serum triglycerides (243.7 +/- 189 mg/dL vs. 172.7 +/- 131 mg/dL, p = 0.015), but not of total cholesterol (TC) or HDL fraction levels. Non-nucleoside reverse transcriptase inhibitors (NNRTI) were associated with an increase in serum TC (180.6 +/- 46.8 mg/dL versus 162.4 +/- 41.4 mg/dL; p= 0.018) and an increase in HDL cholesterol (47.3 +/- 13.8 mg/dL versus 23.3 +/- 24.3 mg/dL; p < 0.001), with no significant effect on triglyceride levels. Lipodystrophy was diagnosed in 59.3% of the patients, but exposure to PI versus NNRTI did not affect the frequency of this disorder (43.4% versus 37.2%; p = 0.68). Serum TC, but not HDL cholesterol or triglyceride levels, was higher among the lipodystrophy cases (183.8 +/-47.5 mg/dL versus 162.1 +/-35.7; p=0.006). Among the controls (patients without lipodystrophy), HDL cholesterol (45.3 +/-14.4 mg/dL vs. 27.1 +/-26.3; p=0.001)and triglyceride levels (178.3 +/-146.3 mg/dL vs. 126.3 +/-126.9; p=0.013) also increased, but not TC. In conclusion, lipodystrophy was highly prevalent in our series. Lipid disorders were also frequent and apparently were related to lipodystrophy, except for triglyceride levels.

Clinical and biochemical evaluation of HIV-related lipodystrophy in an ambulatory population from the Hospital Universitário Cassiano Antonio de Morais, Vitória, ES, Brazil

We designed a retrospective cohort study to identify factors associated with HIV-1 related lipodystrophy at a tertiary HIV-care center in Vitória, ES, Brazil. Inclusion criteria were documented HIV diagnosis, anti-retroviral therapy and age above 17 years. Highly active antiretroviral therapy (HAART) was initially the exposure variable, but a second analysis was also performed, as a nested case-control, based on the presence or absence of lipodystrophy. Use of protease inhibitors (PI) was associated with an increase in serum triglycerides (243.7 ± 189 mg/dL vs. 172.7 ± 131 mg/dL, p = 0.015), but not of total cholesterol (TC) or HDL fraction levels. Non-nucleoside reverse transcriptase inhibitors (NNRTI) were associated with an increase in serum TC (180.6 ± 46.8 mg/dL versus 162.4 ± 41.4 mg/dL; p= 0.018) and an increase in HDL cholesterol (47.3 ± 13.8 mg/dL versus 23.3 ± 24.3 mg/dL; p < 0.001), with no significant effect on triglyceride levels. Lipodystrophy was diagnosed in 59.3 percent of the patients, but exposure to PI versus NNRTI did not affect the frequency of this disorder (43.4 percent versus 37.2 percent; p = 0.68). Serum TC, but not HDL cholesterol or triglyceride levels, was higher among the lipodystrophy cases (183.8 ±47.5 mg/dL versus 162.1 ±35.7; p=0.006). Among the controls (patients without lipodystrophy), HDL cholesterol (45.3 ±14.4 mg/dL vs. 27.1 ±26.3; p=0.001)and triglyceride levels (178.3 ±146.3 mg/dL vs. 126.3 ±126.9; p=0.013) also increased, but not TC. In conclusion, lipodystrophy was highly prevalent in our series. Lipid disorders were also frequent and apparently were related to lipodystrophy, except for triglyceride levels.

[Prevalence of HIV-associated lipodystrophy in Brazilian outpatients: relation with metabolic syndrome and cardiovascular risk factors]. / Prevalência da lipodistrofia associada ao HIV em pacientes ambulatoriais brasileiros: relação com síndrome metabólica e fatores de risco cardiovascular.

Lipodystrophy in HIV-infected patients (LDHIV) affects 40-50% of HIV-infected patients, but there are no data on its prevalence in Brazil. The aim of this study was to assess the LDHIV prevalence among HIV-infected adult Brazilian individuals, as well as to evaluate LDHIV association with cardiovascular risk factors and the metabolic syndrome (MS). It was included 180 adult HIV-infected outpatients consecutively seen in the Infectology Clinic of Universidade Estadual de Londrina. Anthropometric and clinical data (blood pressure, family and personal comorbidities, duration of HIV infection/AIDS, antiretroviral drugs used, CD4+ cells, viral load, fasting glycemia and plasma lipids) were obtained both from a clinical interview as well as from medical charts. LDHIV was defined as the presence of body changes self-reported by the patients and confirmed by clinical exam. MS was defined using the NCEP-ATPIII criteria, reviewed and modified by AHA/NHLBI. A 55% prevalence of LDHIV was found. Individuals with LDHIV presented a longer infected period since HIV infection, longer AIDS duration and longer use of antiretroviral drugs. In multivariate analysis, women (p=0.006) and AIDS duration >8 years (p<0.001) were independently associated with LDHIV. Concerning MS diagnostic criteria, high blood pressure was found in 32%, low HDL-cholesterol in 68%, hypertriglyceridemia in 55%, altered waist circumference in 17% and altered glycemia and/or diabetes in 23% of individuals. Abnormal waist and hypertriglyceridemia were more common in LDHIV-affected individuals. MS was diagnosed in 36%. In multivariate analysis, the factors associated with MS were: BMI >25 kg/m(2) (p<0.001), family history of obesity (p=0.01), indinavir (p=0.001) and age >40 years on HIV first detection (p=0.002). There was a trend to higher frequency of LDHIV among patients with MS (65% versus 50%, p=0.051). LDHIV prevalence among our patients (55%) was similar to previous reports from other countries. MS prevalence in these HIV-infected individuals seems to be similar to the prevalence reported on Brazilian non-HIV-infected adults.