Functional analysis of lower limbs in individuals infected with the human immunodeficiency virus.

OBJECTIVES: The objective of this research was to analyze the functional changes of lower limbs by means of surface electromyography in patients with acquired immunodeficiency syndrome. METHODS: A total of 60 men and women (age mean of 36.77 ± 9.33 years) were divided into two groups: 30 individuals with human immunodeficiency virus group (HIVG) Subtype 1 and 30 healthy individuals control group. Muscle activity was evaluated using surface electromyography (sEMG). sEMG measurements were made while the subjects assumed the static positions: Rest in orthostatism (RS), squat "normalization factor," right and left single leg support (RSLS, LSLS) and during functional activities: Right and left single leg step rise (RSLSR, LSLSR), right and left single leg step down (RSLSD, LSLSD), rising and seating on a chair (RC, SC). RESULTS: To sEMG results revealed statistically significant values in the conditions of RSLS to left semitendinosus muscle, for LSLS to right and left semitendinosus, right rectus femoris and right gluteus medius muscles, for LSLSR to right rectus femoris and right tensor fasciae latae muscles, for RSLSD to right and left semitendinosus and right rectus femoris muscles, for RC to right rectus femoris and left gluteus medius muscles and for SC to right semitendinosus, right rectus femoris and right and left gluteus medius muscles. CONCLUSION: It can be concluded that individuals with acquired immunodeficiency syndrome presented changes in lower limb muscle activity.

Oral Candida spp carriage and periodontal diseases in HIV-infected patients in Ribeirão Preto, Brazil.

The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Bone metabolism dysfunction mediated by the increase of proinflammatory cytokines in chronic HIV infection.

Despite the efficacy of antiretroviral therapy (ART) on the control of viral replication, the current challenge is to decrease the chronic inflammatory status and toxicity of the antiretroviral drugs that contribute to increase the risk of metabolic complications. To verify the influence of proinflammatory cytokines on bone metabolism mediated by chronic HIV infection, a cross-sectional study was conducted with 50 HIV-infected adult men treated or not treated with ART. Dual energy X-ray absorptiometry (DXA) was performed to assess bone mineral density. Biochemical analysis were performed of IL-6, TNF-α, osteocalcin, PTH, 25-OH-D, total calcium, albumin, 24 h urinary calcium, and urinary deoxypyridinoline. The participants not treated with ART exhibited higher values of IL-6 and TNF-α than the participants treated with ART for more than 2 years. The TNF-α values were higher in the participants treated with ART for <2 years than in participants treated with ART for more than 2 years (p < 0.05). The increased values of urinary deoxypyridinoline indicated a high reabsorptive activity of bone tissue in all groups, with a significant difference between the participants not treated with ART and the participants treated with ART for <2 years. Through the DXA we found a bone mass reduction in all bone sites in each group. The increase in production of proinflammatory cytokines, most notably in the viremic group, demonstrated the ability to stimulate osteoclast activity and subsequently affect bone mass. The reduction of bone mineral density was observed in all bone sites, principally for the groups receiving antiretroviral treatment.

Oral Candida spp carriage and periodontal diseases in HIV-infected patients in Ribeirão Preto, Brazil

ABSTRACT The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Upper gastrointestinal Kaposi's sarcoma in HIV-infected patients: ten years of endoscopy observation at a single Brazilian center.

BACKGROUND: Kaposi's sarcoma (KS) is the most common neoplasm among HIV-infected individuals. The frequency of involvement of KS in the gastrointestinal (GI) tract and the associated epidemiological, immune, endoscopic, and histopathological features in HIV-infected patients, were evaluated in this study. METHODS: A review of the medical and endoscopy reports of 1428 HIV-infected patients, who had undergone upper GI endoscopy at the Endoscopy Service, Clinical Hospital, Faculty of Medicine of Ribeirão Preto between January 1999 and June 2009, was performed. Clinical, epidemiological, immunological, endoscopic, and histological data were collected. RESULTS: Twenty-seven (1.9%) patients were diagnosed with GI KS. Patients were predominantly male (81.5%). Sexual activity was the main route of HIV transmission (81.5%). Cutaneous involvement was noted in 21 patients (78%). Fifteen patients (55%) received highly active antiretroviral therapy for a mean duration of 12.6 weeks (range 2-52 weeks) before endoscopy. GI lesions were mainly found in the stomach (55%). Analysis of the immunohistochemical methods HHV8 LNA-1, CD31, and CD34 for the diagnosis of gastric KS indicated high agreement (kappa=0.63, 95% confidence interval 0.32-0.94). There was no relationship between CD4 levels (p=0.34) or HIV viral load (p=0.99) and HHV8 LNA-1 positivity in gastric KS. CONCLUSIONS: GI KS is an infrequent finding in patients with HIV infection. Among those with GI KS, 80% had concomitant skin lesions. Immunohistochemical methods for CD31, CD34, and LNA-1 were important tools in the diagnostic assessment of lesions suggestive of KS in the GI tract. Further studies are required to confirm these data, and the need for routine endoscopic investigation of the GI tract in HIV-infected patients with cutaneous KS should be assessed.

Oral health management of 97 patients living with HIV/AIDS in Ribeirão Preto, São Paulo, Brazil.

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.

Functional analysis of the stomatognathic system in individuals infected with human immunodeficiency virus.

PURPOSE: To understand the effects of HIV type 1 on the function of the masticatory muscles. METHODS: Sixty individuals were selected from both genders, aged between 22 and 57years (mean 36.77±9.33years), and divided into two groups: Group HIVG, 30 individuals with HIV subtype 1, and Group CG, 30 healthy individuals (control group). The individuals were submitted to assessments of their masticatory muscle activity, biting strength and thickness of the masticatory muscles by means of electromyography, maximal molar bite force and ultrasound imaging, respectively. The resultant data were statistically analyzed by t-tests (p<0.05). RESULTS: The HIVG normalized EMG data from a mandibular rest position, protrusion, right and left laterality movement of the jaw showed that HIVG presented a relative increase in EMG activity compared to the CG. The HIVG had a lower masticatory cycle ability while chewing Parafilm M®, Raisins and Peanuts when compared to CG. During rest conditions, the ultrasound images showed a greater average muscular thickness in the right and left temporal region compared to CG. Upon maximal voluntary contraction, an increased average thickness was seen in the temporalis muscles and left sternocleidomastoid muscle when compared to the CG. CONCLUSION: Based on the results of this research, it can be concluded that individuals with acquired immunodeficiency syndrome showed muscular changes related to the stomatognathic system, especially concerning EMG activity and muscle thickness.

A longer time of exposure to antiretroviral therapy improves selenium levels.

BACKGROUND & AIMS: Selenium is an essential mineral for immunological function, performing crucial functions at the cellular level. This micronutrient has been determined to be frequently deficient in HIV infected patients, with correlations between reduced immunological function and greater susceptibility to opportunistic infections. Our aim was to evaluate the influence of time of exposure to antiretroviral therapy (ART) on the biochemical profile of selenium in HIV-infected patients. METHODS: We performed a cross-sectional study on 50 HIV-positive men with different quantitations of viral load and CD4+ T cells, who were either receiving or not receiving ART. Dual energy X-ray absorptiometry (DXA) to determine body composition, biochemical analysis of selenium and albumin, anthropometric measurements were performed. The subjects were divided into groups according to the use of ART or not: The Control Group (CG) was 10 treatment-naïve volunteers, Group G < 2 was 20 volunteers on ART for less than 2 years, and Group G > 2 was 20 volunteers on ART for >2 years. RESULTS: The body mass index showed that all subjects were of normal weight. The group with a longer time of exposure to ART (G > 2) had undetectable viremia and a higher CD4+ T cell count: 593.1 ± 234.6 mm(3). Selenium values (µg/L) were 55.9 ± 11.9 for CG, 52.1 ± 10.5 for G < 2, and 66.9 ± 20.8 for G > 2, with a significant difference between groups G < 2 and G > 2 (p < 0.05), and only G > 2 showed normal selenium values. CONCLUSIONS: Most of the men studied showed selenium deficiency, except for the subjects with a longer exposure to antiretroviral treatment. Thus, an adequate selenium concentration is related to better control of virology and of immunologic function.

Oral health management of 97 patients living with HIV/AIDS in Ribeirão Preto, São Paulo, Brazil

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.

Semen lactoferrin promotes CCL20 production by epithelial cells: Involvement in HIV transmission.

AIM: To study the effect of seminal plasma on Chemokine (C-C motif) ligand 20 (CCL20) production by epithelial cells and its relationship with lactoferrin. METHODS: HEC-1A cells, a cell line derived from a monostratified endocervical epithelium, were incubated with samples of seminal plasma (diluted 1:10 in culture medium) recovered from human immunodeficiency virus (HIV) seronegative (HIV-) or HIV seropositive (HIV+) subjects. Recombinant human interleukin 1 beta (IL-1ß) was used as positive control, and culture medium only as negative control. The measurement of CCL20 production in the supernatants of HEC-1A cells and of lactoferrin in seminal plasma was determined by enzyme-linked immunosorbent assay techniques. A fractionation of seminal plasma proteins was performed by ion exchange chromatography on a pool of seminal plasma specimens from HIV- subjects. Each fraction was tested for its ability to stimulate the production of CCL20 by HEC-1A cells and for its lactoferrin concentration. The HIV viral load in seminal plasma samples from HIV+ patients was measured using the HIV-Monitor kit (Roche Diagnostic Systems, Branchburg, NJ, United States). RESULTS: The positive control IL-1ß was responsible for an increase of 11.36 ± 3.36 times in the production of CCL20. Stimulation of HEC-1A cells was performed in 34 seminal plasma samples (22 from HIV+ subjects and 12 from HIV- subjects). The mean production of CCL20 by HEC-1A in presence of seminal plasma from HIV- and HIV+ subjects was respectively 5.38 ± 0.91 and 7.57 ± 3.26 times higher than that obtained with the untreated cells (P < 0.05 between the two groups). Using the same 34 specimens of seminal plasma, no correlation was observed between the concentration of total proteins in seminal plasma and their ability to stimulate the secretion of CCL20 by HEC-1 cells. In contrast, the ability to produce CCL20 by HEC-1A cells correlated to the concentration of lactoferrin in the seminal plasma samples (r coefficient = 0.56; CI: 0.26-0.76; P < 0.001). After fractionation by ion exchange chromatography, the seminal plasma fractions exhibiting the highest concentrations of lactoferrin were responsible for the greatest stimulation of CCL20 production by HEC-1A cells (r coefficient = 0.89; CI: 0.78-0.95; P < 0.0001). CONCLUSION: Lactoferrin present in seminal plasma correlated with an increased production of CCL20 by HEC-1A cells and therefore could facilitate HIV entry through the genital mucosa.

Influence of antiretroviral therapy and periodontal disease on human salivary beta-defensin 2 in patients infected with HIV.

Studies have addressed periodontal disease biomarkers in salivary proteins associated with innate immunity, mostly due to the alteration in the concentration of many of these proteins in the presence of inflammation. On the other hand, some systemic diseases can modify salivary protein concentrations, which may change their importance or role as specific biomarkers. To study the relationship between periodontal disease and concentrations of human beta-defensin 2 (HBD-2) in the saliva of patients infected and not infected with HIV. To evaluate the association between HBD-2 salivary concentration and viral load, the TCD4+ lymphocyte count (LTCD-4+) and the use of antiretroviral therapy (ART) was assessed in HIV infected patients. Concentrations of HBD-2 were measured in 48 patients not infected with HIV and 53 HIV-infected patients by ELISA, and these data were compared according to periodontal status. Within the group of HIV-infected patients, measures of HBD-2 were assessed according to viral load, LTCD-4+ count and the use of ART. Concentrations of salivary HBD-2 were associated with periodontal disease in non-HIV-infected patients. In HIV-infected patients, salivary HBD-2 was associated with serum status and the use of ART, but it was not related to the periodontal condition. The presence of HBD-2 in the saliva of HIV-infected patients showed no correlations with LTCD-4+ count or viral load. HBD-2 could be a periodontal biomarker in non-HIV-infected patients, but in HIV-infected patients, while salivary HBD- 2 was influenced by the serum status and ART use, it was not correlated with the periodontal condition.

Potential contribution of saliva to the sexual transmission of HIV through the secretion of CCL20 by genital epithelial cells.

Saliva can be considered as an important actor during sexual intercourse. However, there is no data concerning its influence on HIV sexual transmission. The aim of this study was to evaluate the role of whole saliva on the in vitro secretion of CCL20 by monolayered HEC-1A endocervical epithelium cells. HEC-1A cells were cultivated in 96-well microplates and incubated with specimens of whole saliva collected from 57 subjects tested seropositive (n = 34) or seronegative (n = 23) for HIV and presenting different oral conditions (healthy periodontally, n = 22, and gingivitis/periodontitis, n = 35). The production of CCL20 in the supernatants of HEC-1A cells after overnight incubation at 37°C was quantified using ELISA. The salivary concentration of lactoferrin (Lf) and IL-1ß was tested by ELISA. Saliva samples were found able to stimulate dramatically the production of CCL20 by epithelial cells, increasing this synthesis by a mean factor of 38.1 with reference to untreated cells. This stimulation was equivalent to that observed with IL-1ß used as positive control. Although no difference was observed according to oral condition, HIV status or salivary concentration of Lf and IL-1ß, the high salivary concentration of the latter protein could acknowledge in large part for the overproduction of CCL20 by HEC-1A cells when stimulated by saliva. Saliva was shown to significantly increase CCL20 secretion and may be responsible for an enhanced recruitment of dendritic/Langerhans cells at the genital level. These results suggest that saliva could facilitate HIV entry and possibly other pathogens through the genital mucosa during heterosexual intercourse.

Hematological particularities and co-infections in injected drug users with AIDS

HIV patients infected through injected drug use have poorer prognosis than other groups. We evaluated the hematological alterations and rates of co-infections in injected drug use patients with AIDS. Injected drug use patients were younger, predominantly of male gender, and presented lower CD4, total lymphocyte, and platelet counts, but not neutrophil count, than control group. Injected drug use patients had a higher rate of hepatitis C and mycobacteria infection. Furthermore, all injected drug use patients with hemoglobin <10.0 g dL-1 and lymphocyte <1000 µL-1 had CD4 count lower than 100 µL-1. In conclusion, HIV-infected injected drug use patients constitute a special group of patients, and hemoglobin concentration and lymphocyte count can be used as surrogate markers for disease severity.

Hematological particularities and co-infections in injected drug users with AIDS.

HIV patients infected through injected drug use have poorer prognosis than other groups. We evaluated the hematological alterations and rates of co-infections in injected drug use patients with AIDS. Injected drug use patients were younger, predominantly of male gender, and presented lower CD4, total lymphocyte, and platelet counts, but not neutrophil count, than control group. Injected drug use patients had a higher rate of hepatitis C and mycobacteria infection. Furthermore, all injected drug use patients with hemoglobin <10.0 g dL(-1) and lymphocyte <1000µL(-1) had CD4 count lower than 100µL(-1). In conclusion, HIV-infected injected drug use patients constitute a special group of patients, and hemoglobin concentration and lymphocyte count can be used as surrogate markers for disease severity.

Impact of antiretroviral therapy on bone metabolism markers in HIV-seropositive patients.

OBJECTIVE: To evaluate the impact of antiretroviral therapy (ART) on bone and mineral metabolism and to determine the occurrence of osteopenia and/or osteoporosis in HIV-infected patients taking ART or not. METHODS: A cross-sectional study was conducted on 50 HIV-seropositive adult men treated with or not treated with ART. Dual energy X-ray absorptiometry (DXA) was performed and biochemical analyses of the following markers were carried out: FSH, LH, testosterone, total calcium, phosphorus (Pi), magnesium (Mg), albumin, 24h calcium, creatinine, urea, parathormone (PTH), insulin-like growth factor 1 (IGF-I), 25 hydroxyvitamin D (25-OH-D), osteocalcin, and urinary deoxypyridinoline (DPD). The participants were divided into two groups according to ART use or not: Group A, 10 treatment-naive subjects; Group B, ART use for >2years, subdivided into: Group B1, 10 subjects treated with protease inhibitors (PIs) and nucleoside/nucleotide analog reverse transcriptase inhibitors (NRTIs) and Group B2, 10 subjects treated with NRTIs and non-nucleoside analog reverse transcriptase inhibitors (NNRTIs); and Group C, subjects treated with ART <2years, subdivided into: Group C1, 10 subjects treated with PIs and NRTIs and Group C2, 10 subjects treated with NRTIs and NNRTIs. RESULTS: The values of the bone formation marker, osteocalcin, were normal in all groups, whereas urinary DPD values were increased in all groups. Whole body DXA revealed a higher percentage of osteopenia (80%) in Group B2. Lumbar spine DXA showed osteoporosis in Groups A and B1 (10%) and total femur DXA in Group B2 (10%). CONCLUSION: The increased bone reabsorption marker indicated a high reabsorptive activity of bone tissue. These data indicate a greater osteoclastic activity in bone loss in HIV-infected patients on ART.

Which equation should be used to measure energy expenditure in HIV-infected patients? / Qual equação utilizar para avaliar gasto energético de portadores do HIV?

OBJECTIVE: In view of the practical need to use equations for the evaluation of energy expenditure in HIV-infected patients, the objective of the present study was to determine the concordance between the energy expenditure values obtained by indirect calorimetry as the gold standard and those obtained by predictive equations elaborated from data for the healthy population: Harris-Benedict, Schofield and Cunningham, and by equations elaborated from data for HIV-infected patients: Melchior (1991-1993). METHODS: The study was conducted at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto on 32 HIV-infected men under treatment with highly active antiretroviral therapy. Resting energy expenditure was measured by indirect calorimetry and estimated on the basis of measurement of O2 consumption and CO2 production. RESULTS: Statistical analysis revealed weak concordance for the Harris-Benedict (0.38) and Cunningham (0.34) equations and satisfactory concordance for the Schofield equation (0.47). Only the two Melchior equations (1991 and 1993) showed strong concordance with the values obtained by indirect calorimetry (0.63 and 0.66, respectively) and could be used in practice. CONCLUSION: The best equations seem to be population-specific, such as the Melchior equations elaborated for HIV-infected patients.

OBJETIVO: Frente à necessidade prática da utilização de equações para avaliar gasto energético em portadores do HIV, o presente estudo avaliou a concordância dos valores de gasto energético obtidos pelo padrão ouro de calorimetria indireta com equações preditivas desenvolvidas a partir de população saudável: Harris-Benedict, Schofield e Cunningham e equações desenvolvidas a partir de portadores do HIV: Melchior (1991 a 1993). MÉTODOS: O estudo foi realizado no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, com 32 homens portadores do HIV em terapia antirretroviral de alta potência. O gasto energético de repouso foi medido por calometria indireta e estimado a partir de medida de consumo de O2 e produção de CO2. RESULTADOS: De acordo com análise estatística, a concordância foi fraca para equações de Harris-Benedict (0,38) e Cunningham (0,34) e satisfatória para Schofield (0,47). Apenas as duas equações de Melchior apresentaram forte concordância com valores obtidos por calometria indireta (respectivamente 0,63 e 0,66) e poderiam ser utilizadas na prática. CONCLUSÃO:: As melhores equações parecem ser população específica, como as de Melchior, desenvolvidas para portadores do HIV.

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.