Lipodystrophy related to HIV-The Brazilian Public Health approach.

BACKGROUND: Lipodystrophy associated with the human immunodeficiency virus (HIV) is an unpleasant disorder found in 6%-80% of patients infected with HIV. Brazil has a universal public health system, an effective program for patients diagnosed with HIV, providing lipodystrophy treatment since 2004. The objective of this article is to describe the Brazilian approach to this complication. METHOD: A search in the Brazilian Health Care Legislation and the Brazilian Health System database was conducted to identify all the inclusion criteria and surgical treatment offered to HIV patients with lipodystrophy, identify all the facilities that offer this, and describe their geographic distribution. In addition, the number of procedures performed was obtained. RESULTS: The inclusion criteria were the following:1 diagnosis of HIV/AIDS and lipodystrophy due to the use of antiretroviral drugs for at least 12 months;2 no response or the impossibility of changing ART;3 clinical stability for six months without clinical manifestations suggestive of immunodeficiency in the last 6 months;4 laboratory results showing CD4 cell count >250 cells/mm3 and viral load <10,000 copies/ml in the last 6 months; and5 stable clinical and laboratory parameters. A total of 4,760 procedures were performed, with the most common procedure being facial filler with polymethylmethacrylate. Eleven hospitals were registered to offer this treatment. CONCLUSION: The Brazilian Health Care System approach to lipodystrophy has an organized plan with universal and integral coverage. All the procedures offered were safe and well-tolerated, according to the literature. However, regional distribution is the main issue and needs to be improved.

Self-reported lipodystrophy, nutritional, lipemic profile and its impact on the body image of HIV-1-infected persons, with and without antiretroviral therapy.

A cross-sectional study was conducted with 227 adults, 162 using antiretroviral therapy (ART), both sexes, in Secondary Immunodeficiency Outpatient Clinic of the Department of Dermatology of the Hospital das Clínicas of the Faculty of Medicine of University of São Paulo. The patients were grouped into 92 under ART and self-reported lipodystrophy (G1); 70 under ART and without self-reported lipodystrophy (G2); 65 without ART (G3). We evaluated: (1) self-reported lipodystrophy, self-perception and feeling about body image; (2) Anthropometric and lipemic profile. We included 67% (n = 152) male; 33% (n = 77) female. There was a negative impact of self-reported lipodystrophy on body image, where female was more critical, although it was significant for male (p = 0.014). BMI revealed excess weight in female (p = 0.058). Hip waist ratio was shown to be a better parameter than abdominal perimeter when measuring fat in central region of male and lipohypertrophy was characterized in both sexes. There was lipoatrophy in upper and lower limbs for individuals of the (G1) and the male of this group presented hypertriglyceridemia, (p = 0.012). There was a difference in sex, pattern of self - perceived morphologic alterations and feeling in relation to body image when associated with self - reported lipodystrophy, ART use, anthropometric and lipemic profile.

Acquired Lipodystrophy Associated With Nivolumab in a Patient With Advanced Renal Cell Carcinoma.

CONTEXT: Lipodystrophy syndromes are rare disorders characterized by the selective loss of adipose tissue. We aimed to report a case of acquired generalized lipodystrophy possibly associated with nivolumab. CASE DESCRIPTION: A woman was referred to our Endocrinology Department for uncontrolled diabetes mellitus. At 50 years of age, she was diagnosed with type 2 diabetes after a routine laboratory test and her diabetes was well controlled with low doses of metformin. In 2010, she was diagnosed with clear cell renal carcinoma. The cancer progressed in the following years, leading to the initiation of treatment with nivolumab in 2017. Two months later she presented with facial lipoatrophy, with loss of the buccal fat pads and prominent zygomatic arch. Her neck, shoulders, arms, and buttocks were also affected. Her diabetes control worsened. She received maximal doses of metformin and pioglitazone and was administered 1.5 units/kg/d insulin. Subcutaneous biopsy of medial surface of the arm revealed chronic lobular panniculitis. Despite nivolumab's possible involvement in the onset of lipodystrophy, the maintenance of nivolumab therapy was justified by the observed reduction in the progression of the cancer, combined with the lack of an alternative chemotherapy. The therapy was withdrawn after 8 months of treatment because of grade 3 hepatitis. CONCLUSION: Anti-PD1 therapy has great potential. Early recognition of the onset of unusual collateral effects is important to improve decision making regarding the treatment of patients with tumors.

Aerobic capacity and health-related quality of life in adults HIV-infected patients with and without lipodystrophy

Abstract Introduction HIV infection and its therapy which can affect their aerobic capacity and health-related quality of life of patients. Objective We conducted a cross-sectional study to determine if aerobic capacity and health related quality of life was decreased in HIV-infected patients receiving highly active antiretroviral therapy and comparing patients with and without lipodystrophy. Research design and methods HIV-infected patients older than 18 years, and in current use of highly active antiretroviral therapy drugs, were evaluated for blood count, fasting total cholesterol, high density lipoprotein, triglycerides, glucose, HIV viral load and CD4/CD8 counts, body composition, peak oxygen consumption (peak VO2) and metabolic equivalent. Health related quality of life was assessed by using Short Form-36 (SF-36). Statistical analysis was carried out using SPSS version 20.0. Results A total of 63 patients with mean age of 43.1 ± 6.4 years were evaluated, of these 34 (54%) had lipodystrophy. The average peak VO2 (31.4 ± 7.6 mL kg−1 min−1) was significantly lower (p < 0.01) than expected values (37.9 ± 5.6 mL kg−1 min−1) according to the characteristics of the patients. The lipodystrophy group presented with a significant difference in muscle mass, body fat, peak VO2 and metabolic equivalent and in functional capacity domains of SF-36. Conclusion Aerobic capacity values were reduced in HIV-infected patients under highly active antiretroviral therapy when compared to predicted values. Lipodystrophy was associated with reduced aerobic capacity and higher frequency of metabolic syndrome. Lifestyle modification should be a priority in the management of chronic HIV disease.

Aerobic capacity and health-related quality of life in adults HIV-infected patients with and without lipodystrophy.

INTRODUCTION: HIV infection and its therapy which can affect their aerobic capacity and health-related quality of life of patients. OBJECTIVE: We conducted a cross-sectional study to determine if aerobic capacity and health related quality of life was decreased in HIV-infected patients receiving highly active antiretroviral therapy and comparing patients with and without lipodystrophy. RESEARCH DESIGN AND METHODS: HIV-infected patients older than 18 years, and in current use of highly active antiretroviral therapy drugs, were evaluated for blood count, fasting total cholesterol, high density lipoprotein, triglycerides, glucose, HIV viral load and CD4/CD8 counts, body composition, peak oxygen consumption (peak VO2) and metabolic equivalent. Health related quality of life was assessed by using Short Form-36 (SF-36). Statistical analysis was carried out using SPSS version 20.0. RESULTS: A total of 63 patients with mean age of 43.1±6.4 years were evaluated, of these 34 (54%) had lipodystrophy. The average peak VO2 (31.4±7.6mLkg(-1)min(-1)) was significantly lower (p<0.01) than expected values (37.9±5.6mLkg(-1)min(-1)) according to the characteristics of the patients. The lipodystrophy group presented with a significant difference in muscle mass, body fat, peak VO2 and metabolic equivalent and in functional capacity domains of SF-36. CONCLUSION: Aerobic capacity values were reduced in HIV-infected patients under highly active antiretroviral therapy when compared to predicted values. Lipodystrophy was associated with reduced aerobic capacity and higher frequency of metabolic syndrome. Lifestyle modification should be a priority in the management of chronic HIV disease.

Availability of data on adverse reactions to antiretroviral drugs in medical charts according to the Naranjo algorithm: an example of a Brazilian historical cohort.

BACKGROUND AND OBJECTIVE: Although not designed for research purposes, medical charts can be a unique source for obtaining information on long-term adverse drug reactions. This study aimed to assess the availability of key information on paper-based patient medical records needed to detect long-term adverse reactions to antiretroviral therapy (ART). METHODS: This is an ongoing historical cohort study carried out in three public HIV/AIDS referral centers in Belo Horizonte, Brazil. Medical charts of treatment-naïve HIV-infected adult patients initiating ART between 2001 and 2005 were reviewed for a follow-up period of up to 5 years after the first ART prescription. Descriptive analysis was performed by estimating the absolute and relative frequencies of selected variables. The Naranjo algorithm was employed to assess the availability of data on long-term adverse outcomes in medical charts. RESULTS: A total of 233 medical charts were eligible for study and 26.1% contained at least one long-term adverse reaction, corresponding to 45 cases of dyslipidemia (19.3%), 16 (6.9%) of lipodystrophy and 5 of type 2 diabetes mellitus (2.1%). Temporal relationship and ART switch could be better documented from medical charts. Information on reasons for ART switching and alternative causes for adverse reactions was very lacking. CONCLUSIONS: Specific tools should be developed and included in medical routines to improve adverse reaction reporting by physicians and other health professionals. This could be implemented simultaneously with the transition from paper to electronic medical charts in Brazil, facilitating the identification of long-term adverse reactions to antiretroviral drugs in epidemiological studies and in clinical practice.

Evaluation of adverse events associated with antiretroviral therapy and the relationship to treatment adherence.

Despite the effectiveness of highly active antiretroviral therapy (HAART), many adverse events (AEs) are associated with the use of these drugs, thus affecting treatment adherence. The aim of this study was to evaluate AE incidence with the use of HAART and the relationship to treatment adherence. This was a retrospective observational study conducted with patients who experienced serious AEs related to HAART, resulting in the need to change the therapeutic regimen. To calculate adherence, the dates the patients received HAART were used. From January 2009 to December 2011, 168 AE cases associated with antiretroviral drugs were observed. Of the total study population, 58% of the patients were male. The side effects were associated with 12 drugs, of which 58.3% were nucleoside analogues reverse transcriptase inhibitors (NRTIs). In addition, 16.7% were non-nucleoside reversetranscriptase inhibitors (NNRTIs), and 25% were protease inhibitors (PIs). The NRTIs and PIs presented similar numbers of AEs, whereas the NNRTIs resulted in less than 50% of the reported AEs compared to other drug classes. The low adherence observed in patients with severe AEs that force treatment regimen change suggests that the occurrence of side effects could be one of the obstacles affecting the adherence and thus the effectiveness of HAART.

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/AIDS.

OBJECTIVE: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. METHOD: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. RESULTS: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. CONCLUSION: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids / Alterações corporais: terapia antirretroviral e síndrome da lipodistrofia em pessoas vivendo com HIV/AIDS / Alteraciones corporales: terapia antirretroviral y síndrome de la lipodistrofia en personas que viven con VIH/SIDA

OBJECTIVE: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. METHOD: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. RESULTS: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. CONCLUSION: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.

OBJETIVO: identificar os diferentes tipos de alterações morfológicas da síndrome da lipodistrofia (SL) em pacientes dos atendimentos ambulatoriais e relacioná-las ao esquema terapêutico utilizado. MÉTODO: estudo transversal, para o qual foram recrutados 60 pacientes com HIV e SL e 79 sem a SL, que consentiram entrevista e coleta de dados em prontuário. RESULTADOS: a região mais acometida pela lipoatrofia foi a face; pela lipo-hipertrofia o abdome e pela forma mista as alterações em abdome, face, membros superiores e inferiores. CONCLUSÃO: dentre os esquemas terapêuticos, o composto pela zidovudina, lamivudina e efavirenz pareceu proteger contra a SL. A enfermagem pode atuar na identificação precoce das alterações, além de fornecer orientações e apoio aos pacientes acometidos pelas mudanças na imagem corporal.

OBJETIVO: identificar los diferentes tipos de alteraciones morfológicas del Síndrome de la lipodistrofia (SL) en pacientes de los servicios de ambulatorio y relacionarlas al esquema terapéutico utilizado. MÉTODO: estudio transversal en lo que fueron reclutados 60 pacientes con VIH y la SL y 79 sin la SL, que consintieron entrevista y recogida de datos en prontuario. RESULTADOS: la región más acometida por la lipoatrofia fue la cara; por la lipohipertrofia el Abdomen y por la forma mixta las alteraciones en Abdomen, cara, miembros superiores e inferiores. CONCLUSIÓN: entre los esquemas terapéuticos, el compuesto por la zidovudina, lamivudina y efavirenz pareció proteger contra la SL. La enfermería puede actuar en la identificación precoz de las alteraciones, además de suministrar orientaciones y apoyo a los pacientes acometidos por los cambios en la imagen corporal.

What should we know about metabolic syndrome and lipodystrophy in AIDS?

OBJECTIVE: Prevalence of chronic complications of HIV infection is increasing and early recognition and treatment of the components of metabolic syndrome (MS) are essential to prevent cardiovascular and metabolic complications. Considering this, we performed a cross-sectional study on the prevalence and risk-factors for MS among HIV-infected subjects. METHODS: A total of 819 patients followed at a large outpatient HIV unit were assessed by an interviewer-administered questionnaire that recorded several demographic, epidemiologic, clinical, laboratory, and social variables. Lipodystrophy diagnosis relied on agreement between patient's self-report and physician's observation of altered body-fat deposits. The presence of three or more of the following characteristics identified MS: increased waist circumference, hypertriglyceridemia, low HDL cholesterol level, hypertension, and hyperglycemia. We used logistic regression analyses to study variables independently associated with MS. RESULTS: The prevalence of MS was 20.6% and that of lipodystrophy was 38.5%. 61 (36.1%) out of 169 patients with MS had also lipodystrophy. Patients with metabolic syndrome were significantly more likely to be older (OR = 1.08), had higher CD4 counts (OR = 1.001), had an increased body mass index (OR = 1.27) and had longer exposure to antiretroviral therapy (OR = 1.01) than those without metabolic syndrome. CONCLUSION: Both traditional risk factors for cardiovascular disease and factors associated with HIV infection itself, such as an increased CD4 cell count and a longer exposure to antiretroviral therapy, seem to be associated with metabolic syndrome in the present study population.

What should we know about metabolic syndrome and lipodystrophy in AIDS? / O que devemos saber sobre síndrome metabólica e lipodistrofia na AIDS?

OBJECTIVE: Prevalence of chronic complications of HIV infection is increasing and early recognition and treatment of the components of metabolic syndrome (MS) are essential to prevent cardiovascular and metabolic complications. Considering this, we performed a cross-sectional study on the prevalence and risk-factors for MS among HIV-infected subjects. METHODS: A total of 819 patients followed at a large outpatient HIV unit were assessed by an interviewer-administered questionnaire that recorded several demographic, epidemiologic, clinical, laboratory, and social variables. Lipodystrophy diagnosis relied on agreement between patient's self-report and physician's observation of altered body-fat deposits. The presence of three or more of the following characteristics identified MS: increased waist circumference, hypertriglyceridemia, low HDL cholesterol level, hypertension, and hyperglycemia. We used logistic regression analyses to study variables independently associated with MS. RESULTS: The prevalence of MS was 20.6 percent and that of lipodystrophy was 38.5 percent. 61 (36.1 percent) out of 169 patients with MS had also lipodystrophy. Patients with metabolic syndrome were significantly more likely to be older (OR = 1.08), had higher CD4 counts (OR = 1.001), had an increased body mass index (OR = 1.27) and had longer exposure to antiretroviral therapy (OR = 1.01) than those without metabolic syndrome. CONCLUSION: Both traditional risk factors for cardiovascular disease and factors associated with HIV infection itself, such as an increased CD4 cell count and a longer exposure to antiretroviral therapy, seem to be associated with metabolic syndrome in the present study population.

OBJETIVO: A prevalência de complicações crônicas da infecção HIV está aumentando, e o reconhecimento precoce e o tratamento dos componentes da síndrome metabólica (SM) são essenciais para a prevenção de complicações cardiovasculares e metabólicas. Considerando isso, realizamos um estudo transversal sobre prevalência e fatores de risco para SM em indivíduos HIV+. MÉTODOS: Um total de 819 pacientes acompanhados em um ambulatório de HIV foi avaliado por um entrevistador que registrou em questionário dados demográficos, epidemiológicos, clínicos, laboratoriais e variáveis sociais. O diagnóstico de lipodistrofia baseou-se na concordância entre autorrelato do paciente e observação do médico das alterações de gordura corporal. A SM foi identificada pela presença de três ou mais das seguintes características: circunferência abdominal aumentada, hipertrigliceridemia, colesterol HDL baixo, hipertensão e hiperglicemia. Análises de regressão logística foram utilizadas para identificar variáveis associadas à SM. RESULTADOS: A prevalência de SM foi 20,6 por cento e de lipodistrofia foi 38,5 por cento. Entre os 169 pacientes com SM, 61 (36,1 por cento) apresentavam lipodistrofia. Os pacientes com síndrome metabólica tinham, significativamente, maior probabilidade de ser mais velhos (OR = 1,08), ter maior contagem de CD4 (OR = 1,001), ter maior índice de massa corporal (OR = 1,27) e ter maior tempo de exposição à terapia antirretroviral (OR = 1,01). CONCLUSÃO: Tanto fatores de risco tradicionais para doença cardiovascular quanto fatores associados à infecção HIV, como aumento da contagem de CD4 e maior exposição à terapia antirretroviral, parecem estar associados à SM na população estudada.

Antiretroviral therapy-associated dyslipidemia in patients from a reference center in Brazil.

The aim of this study was to determine the impact of antiretroviral therapy on the lipid profile of human immunodeficiency virus (HIV) patients before and after the initiation of highly active antiretroviral therapy (HAART). This was a cross-sectional analysis of patients receiving HAART at a reference center in Belo Horizonte, Brazil, on the basis of medical records from 2002 to 2006. Patients were included if they had at least one lipid test or a clinical or laboratory diagnosis of dyslipidemia/lipodystrophy. Among the 692 patients, 620 met the eligibility criteria. The majority were males (66.5%), middle age (average 39 years), had a low educational level (60.4%), and low income (51.0%). HAART duration ranged from 11 days to 4.6 years, with a mean of 28.6 months (SD = ± 470.19 days). The prevalence of dyslipidemia/lipodystrophy nearly tripled (11.3% pre- and 32.4% post-HAART). Dyslipidemia was associated with older age (P = 0.007), nucleoside reverse transcriptase inhibitor (NRTI) + protease inhibitor (PI) regimens (P = 0.04), NRTI + non-NRTI (NNRTI) regimens (P = 0.026), the use of stavudine (d4T) in any regimen (P = 0.002) or in NRTI-based regimens (P = 0.006), and longer exposure to HAART (P < 0.000). In addition, there was no correlation between dyslipidemia and gender (P = 0.084). Only 2.0% of the patients received treatment for dyslipidemia during the trial. These results show a need for continuous monitoring of patients under antiretroviral therapy, particularly those using NRTI-based regimens, especially when combined with d4T and PIs. Secondly, interventions should be developed to correct metabolic changes.

Antiretroviral therapy-associated dyslipidemia in patients from a reference center in Brazil

The aim of this study was to determine the impact of antiretroviral therapy on the lipid profile of human immunodeficiency virus (HIV) patients before and after the initiation of highly active antiretroviral therapy (HAART). This was a cross-sectional analysis of patients receiving HAART at a reference center in Belo Horizonte, Brazil, on the basis of medical records from 2002 to 2006. Patients were included if they had at least one lipid test or a clinical or laboratory diagnosis of dyslipidemia/lipodystrophy. Among the 692 patients, 620 met the eligibility criteria. The majority were males (66.5 percent), middle age (average 39 years), had a low educational level (60.4 percent), and low income (51.0 percent). HAART duration ranged from 11 days to 4.6 years, with a mean of 28.6 months (SD = ± 470.19 days). The prevalence of dyslipidemia/lipodystrophy nearly tripled (11.3 percent pre- and 32.4 percent post-HAART). Dyslipidemia was associated with older age (P = 0.007), nucleoside reverse transcriptase inhibitor (NRTI) + protease inhibitor (PI) regimens (P = 0.04), NRTI + non-NRTI (NNRTI) regimens (P = 0.026), the use of stavudine (d4T) in any regimen (P = 0.002) or in NRTI-based regimens (P = 0.006), and longer exposure to HAART (P < 0.000). In addition, there was no correlation between dyslipidemia and gender (P = 0.084). Only 2.0 percent of the patients received treatment for dyslipidemia during the trial. These results show a need for continuous monitoring of patients under antiretroviral therapy, particularly those using NRTI-based regimens, especially when combined with d4T and PIs. Secondly, interventions should be developed to correct metabolic changes.

Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects.

Several side effects have been strongly associated with antiretroviral therapy in HIV patients. Among them, the lipodystrophy syndrome which presents alterations in body shape with central adipose hypertrophy and peripheral lipoatrophy, reported by patients as a visible marker identifying them as HIV patients. This manuscript presents an analysis of current literature regarding the psychosocial aspects of HIV patients with lipodystrophy associated with antiretroviral therapy. The results show that the alterations in body shape can be disturbing in terms of psychosocial well being, affecting quality of life and increasing the stigma associated with the disease, with consequent disturbances in social relations. This analysis provides a preliminary review of the psychosocial aspects of lipodystrophy and further studies are needed for a better understanding of this complex syndrome, which could provide new information to be used in nursing care for HIV patients affected by this problem.

Lipodystrophy syndrome associated with antiretroviral therapy in HIV patients: considerations for psychosocial aspects: [review] / Síndrome de la lipodistrofia asociado con la terapia antiretroviral en pacientes con VIH: consideraciones para los aspectos psicosociales: [revisión] / Sindrome da lipodistrofia associada com a terapia anti-retroviral em portadores do HIV: considerações para os aspectos psicossociais: [revisão]

Several side effects have been strongly associated with antiretroviral therapy in HIV patients. Among them, the lipodystrophy syndrome which presents alterations in body shape with central adipose hypertrophy and peripheral lipoatrophy, reported by patients as a visible marker identifying them as HIV patients. This manuscript presents an analysis of current literature regarding the psychosocial aspects of HIV patients with lipodystrophy associated with antiretroviral therapy. The results show that the alterations in body shape can be disturbing in terms of psychosocial well being, affecting quality of life and increasing the stigma associated with the disease, with consequent disturbances in social relations. This analysis provides a preliminary review of the psychosocial aspects of lipodystrophy and further studies are needed for a better understanding of this complex syndrome, which could provide new information to be used in nursing care for HIV patients affected by this problem.

Varios efectos secundarios han sido fuertemente asociados con la terapia antiretroviral en pacientes con HIV. Entre ellos, el síndrome de la lipodistrofia se presenta con alteraciones en la forma del cuerpo con hipertrofia adiposa central y lipoatrofia periférica, las cuales son reportadas por pacientes como marcas visibles que los identifica como pacientes con VIH. En este manuscrito, presentamos un análisis de literatura actual con respecto a los aspectos psicosociales de pacientes con VIH presentándose con lipodistrofia asociado con la terapia antiretroviral. Los resultados demuestran que las alteraciones de la forma del cuerpo pueden ser inquietantes en lo que se refiere al bienestar psicosocial, afectando la calidad de vida y aumentando el estigma asociado con la enfermedad, con las consiguientes dificultades en las relaciones sociales. Este análisis provee un repaso preliminar de los aspectos psicosociales de la lipodistrofia; sin embargo, otros estudios son necesarios para entender mejor este complejo síndrome, proveyendo nueva información para ser utilizada en el cuidado de enfermería para pacientes con VIH que están afectados por este problema.

Diversos efeitos colaterais têm sido associados à terapia anti-retroviral em portadores da infecção pelo HIV, dentre esses, a síndrome da lipodistrofia apresentando hiperlipidemia e alterações na forma do corpo, com hipertrofia adiposa central e lipoatrofia periférica, relatada pelos pacientes como um visível marcador para a identificação de portadores da infecção pelo HIV. Este estudo consiste em análise da produção científica sobre aspectos psicossociais em portadores da infecção pelo HIV que apresentam lipodistrofia associada à utilização da terapia anti-retroviral. Os resultados mostram que alterações corporais podem ser suficientemente perturbadoras para o bem-estar psicossocial, afetando a qualidade de vida e aumentando o estigma da doença, ocasionando perturbações nas relações sociais. Esta revisão possibilita uma análise preliminar dos aspectos psicossocias da lipodistrofia; entretanto, outros estudos são necessários para o melhor entendimento desta complexa síndrome, trazendo novas informações a serem utilizadas no cuidado de enfermagem a portadores da infecção pelo HIV afetados por este problema.

Exercise training in HIV-1-infected individuals with dyslipidemia and lipodystrophy.

PURPOSE: Highly active antiretroviral therapy has improved the prognosis of human immuno deficiency virus type 1 (HIV-1)-infected individuals, but it has been associated with the development of metabolic and fat distribution abnormalities known as the lipodystrophy syndrome. This study tested the hypothesis that aerobic exercise training added to a low-lipid diet may have favorable effects in HIV-1-infected individuals with dyslipidemia and lipodystrophy. METHODS: Thirty healthy subjects, carriers of HIV-1, with dyslipidemia and lipodystrophy, all of whom were using protease inhibitors and/or non-nucleoside reverse transcriptase inhibitors, were randomly assigned to participate in either a 12-wk program of aerobic exercise or a 12-wk stretching and relaxation program. All subjects received recommendations for a low-lipid diet. Before and after intervention, peak oxygen uptake, body composition, CD4, viral load, lipid profile, and plasma endothelin-1 levels were measured. RESULTS: Peak oxygen uptake increased significantly in the diet and exercise group (mean +/- SD: 32 +/- 5 mL x kg(-1) x min(-1) before; 40 +/- 8 mL x kg(-1) x min(-1) after) but not in the diet only group (34 +/- 7 mL x kg(-1) x min(-1) before; 35 +/- 8 mL x kg(-1) x min(-1) after). Body weight, body fat, and waist-to-hip ratio decreased significantly and similarly in the two groups. There were no significant changes in immunologic variables in either group. Likewise, plasma triglycerides, total cholesterol, and HDL cholesterol levels did not change significantly in either group. Plasma endothelin-1 levels were elevated in both groups and presented no significant changes during the study. CONCLUSION: HIV-seropositive individuals with lipodystrophy and dyslipidemia submitted to a short-term intervention of low-lipid diet and aerobic exercise training are able to increase their functional capacity without any consistent changes in plasma lipid levels.