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2.
BMC Infect Dis ; 18(1): 357, 2018 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-30064371

RESUMO

BACKGROUND: Dyslipidemia represents a significant non-infectious comorbidity among people living with HIV. The aim of this study is to evaluate the impact on lipid profile of switches from an efavirenz (EFV) or protease inhibitor/ritonavir (PI/r)-based regimen to a rilpivirine (RPV) or a once-daily integrase inhibitor-based regimen. METHODS: We analyzed data from SCOLTA prospective database. All patients with HIV-RNA < 50 copies/ml in therapy with two NRTI + EFV or PI/r were included if they switched from EFV to dolutegravir (group EFV-DTG), elvitegravir (EFV-EVG), or RPV (EFV-RPV) and from PI/r to DTG (PI/r-DTG), PI/r to EVG (PI/r-EVG), or PI/r to RPV (PI/r-RPV). Total cholesterol (TC), TC/HDL ratio, LDL-cholesterol (LDL) and triglycerides (TG) were compared at baseline, six months and one year. Comparisons among groups were performed by a general linear model. RESULTS: Four hundred and ninety patients were enrolled, 24.9% female, mean age 47.3 years (±10.1). According to ART switch, 11.4% were classified in group EFV-DTG, 3.9% in EFV-EVG, 23.9% in EFV-RPV, 17.6% in PI/r-DTG, 17.8% in PI/r-EVG, and 25.5% in PI/r-RPV. After adjusted analysis, TC significantly decreased in all groups but EFV-EVG, TC/HDL in all but EFV-DTG and EFV-EVG, while the reduction of TG was significant only in switches to RPV (EFV-RPV and PI/r-RPV). The one year decrease of TC, TC/HDL, LDL and TG was higher in patients with higher baseline levels of the same variable (p < .0001 for all). CONCLUSIONS: In SCOLTA, all switches from PI/r regimens gave advantages on lipid profile, while stopping EFV had consistently favorable lipid effects only if replaced by RPV.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Substituição de Medicamentos , Infecções por HIV/tratamento farmacológico , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Inibidores de Integrase/administração & dosagem , Lipídeos/sangue , Rilpivirina/uso terapêutico , Adulto , Benzoxazinas/uso terapêutico , Estudos de Coortes , Esquema de Medicação , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Síndrome de Lipodistrofia Associada ao HIV/sangue , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Inibidores de Proteases/administração & dosagem , Ritonavir/administração & dosagem , Resultado do Tratamento
3.
J Clin Densitom ; 21(1): 75-82, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28034590

RESUMO

In HIV-infected patients, combined antiretroviral therapy (cART) is associated to adipose tissue redistribution known as lipodystrophy and associated cardiometabolic risk. This study aimed to evaluate the evolution of body composition in HIV-infected patients, with and without lipodystrophy, over 2 yr. We evaluated anthropometric parameters and body composition by whole-body dual-energy X-ray absorptiometry in 144 HIV-infected patients on cART. We defined lipodystrophy by fat mass ratio. Lipodystrophy was present in 45.77% of the patients. These patients presented higher HIV infection duration, cART duration, and CD4+ cell count, with no differences regarding gender, age, body mass index, and viral load. Patients with lipodystrophy showed an increase in total fat mass (9.9%) and upper-limbs fat mass (17.6%), with a decrease in total, trunk, and lower-limbs fat-free mass (2.2%; 2.2%, and 3.9%, respectively), over 2 yr. In patients without lipodystrophy, the trunk fat-free mass decreased 1.9% over time, and no changes were observed in the other studied parameters. In patients with lipodystrophy, there was predominantly a central fat mass gain, with no changes in lower limbs, suggesting that peripheral adipocytes lose their regenerative capacity.


Assuntos
Adiposidade , Fármacos Anti-HIV/uso terapêutico , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Síndrome de Lipodistrofia Associada ao HIV/fisiopatologia , Absorciometria de Fóton , Adulto , Índice de Massa Corporal , Contagem de Linfócito CD4 , Quimioterapia Combinada , Feminino , Síndrome de Lipodistrofia Associada ao HIV/imunologia , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Estudos Longitudinais , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Gordura Subcutânea/diagnóstico por imagem , Tronco , Extremidade Superior , Circunferência da Cintura , Relação Cintura-Quadril
4.
J Infect Dis ; 217(4): 521-528, 2018 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-29165684

RESUMO

Despite achieving human immunodeficiency virus type 1 (HIV-1) RNA suppression below levels of detection and, for most, improved CD4+ T-cell counts, those aging with HIV experience excess low-level inflammation, hypercoagulability, and immune dysfunction (chronic inflammation), compared with demographically and behaviorally similar uninfected individuals. A host of biomarkers that are linked to chronic inflammation are also associated with HIV-associated non-AIDS-defining events, including cardiovascular disease, many forms of cancer, liver disease, renal disease, neurocognitive decline, and osteoporosis. Furthermore, chronic HIV infection may interact with long-term treatment toxicity and weight gain after ART initiation. These observations suggest that future biomarker-guided discovery and treatment may require attention to multiple biomarkers and, possibly, weighted indices. We are clinical trialists, epidemiologists, pragmatic trialists, and translational scientists. Together, we offer an operational definition of a biomarker and consider how biomarkers might facilitate progress along the translational pathway from therapeutic discovery to intervention trials and clinical management among people aging with or without HIV infection.


Assuntos
Antirretrovirais/uso terapêutico , Biomarcadores/análise , Pesquisa Biomédica/tendências , Descoberta de Drogas/tendências , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Resposta Viral Sustentada , Complexo AIDS Demência/tratamento farmacológico , Complexo AIDS Demência/patologia , Nefropatia Associada a AIDS/tratamento farmacológico , Nefropatia Associada a AIDS/patologia , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/patologia , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Síndrome de Lipodistrofia Associada ao HIV/patologia , Humanos
5.
Rev. bras. cir. plást ; 32(3): 398-401, jul.-set. 2017.
Artigo em Inglês, Português | LILACS | ID: biblio-868283

RESUMO

INTRODUÇÃO: Desde a introdução do tratamento do HIV com uso da terapia antirretroviral altamente ativa, a mortalidade por essa doença foi reduzida drasticamente em todo o mundo. Um dos parefeitos relacionados à utilização desses fármacos é a lipodistrofia glútea. O objetivo deste trabalho é verificar o impacto da correção dessa deformidade na qualidade de vida de pacientes com HIV. MÉTODOS: Foi conduzido um estudo de coorte histórica com 23 pacientes submetidos à gluteoplastia com implante intramuscular, entre janeiro de 2010 e dezembro de 2014, avaliando a qualidade de vida por meio do em Nottingham Health Profile em. As informações foram coletadas de julho a agosto de 2015. A análise estatística foi feita utilizando-se o em Related-Samples McNemar Test em. RESULTADOS: strong Houve diferença significativa entre o pré-operatório e pós-operatório em 19 das 38 perguntas. CONCLUSÃO: É possível afirmar que a reconstrução glútea melhora a qualidade de vida de pacientes HIV positivos acometidos por lipodistrofia glútea relacionada a antirretrovirais.


INTRODUCTION: Since the introduction of highly active antiretroviral therapy for the treatment of human immunodeficiency virus (HIV), disease mortality has been dramatically reduced worldwide. One related side effect from the use of these drugs is gluteal lipodystrophy. The aim of this study is to assess the quality-of-life impact of correcting this deformity in HIV patients. METHODS: A historical cohort study was conducted between January 2010 and December 2014 with 23 patients, assessing the quality of their lives using the Nottingham Health Profile. A statistical analysis was performed using the McNemar test for related samples. RESULTS: There was a significant difference between preoperative and postoperative response in 19 of the 38 questions. CONCLUSION: We may say that gluteal reconstruction plays a role in improving quality of life for HIV patients who have been affected by antiretroviral related gluteal lipodystrophy.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , História do Século XXI , Qualidade de Vida , Anormalidades Congênitas , Nádegas , Estudos de Coortes , HIV , Infecções por Retroviridae , Síndrome de Lipodistrofia Associada ao HIV , Antirretrovirais , Lipodistrofia , Sistemas de Medicação , Anormalidades Congênitas/cirurgia , Nádegas/cirurgia , HIV/efeitos dos fármacos , Infecções por Retroviridae/tratamento farmacológico , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Antirretrovirais/análise , Antirretrovirais/farmacologia , Lipodistrofia/tratamento farmacológico , Sistemas de Medicação/história
6.
Ann Nutr Metab ; 70(1): 66-73, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28278503

RESUMO

BACKGROUND: Several studies have reported increased resting energy expenditure (REE) in human immunodeficiency virus (HIV)-infected patients with HIV-associated lipodystrophy syndrome (HALS). However, limited data exist on the total energy expenditure (TEE). This study was aimed at evaluating the REE and TEE of HIV-infected patients with and without HALS by using the doubly labeled water (DLW) technique and the activity monitor based on accelerometry system (AM), and comparing the results obtained using both methods. METHODS: Evaluated total of 45 HIV+ men undergoing antiretroviral therapy, including 18 LIPO- (without lipodystrophy) and 27 LIPO+ (with lipodystrophy) individuals were evaluated. Habitual physical activity patterns were measured by using the ActivPAL™ AM system, REE by indirect calorimetry, and TEE by DLW and AM. RESULTS: No significant differences were found between LIPO- and LIPO+ in REE (1,433 ± 196 vs. 1,510 ± 203 kcal), TEE-DLW (2,691 ± 856 vs. 2,618 ± 415 kcal) and TEE-AM (2,560 ± 458 vs. 2,594 ± 456 kcal), respectively. RQ was a predictor of REE in LIPO+. TEE estimated by the AM had a moderate correlation with DLW, but there was a wide variance in the intra-subject results. CONCLUSIONS: TEE is not increased in HIV-infected patients with HALS. AM should be used with caution for TEE evaluation during clinical practice.


Assuntos
Antirretrovirais/uso terapêutico , Metabolismo Energético , Síndrome de Lipodistrofia Associada ao HIV/metabolismo , Acelerometria , Adulto , Calorimetria Indireta , Óxido de Deutério , Infecções por HIV/tratamento farmacológico , Infecções por HIV/metabolismo , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Adulto Jovem
7.
J Drugs Dermatol ; 15(9): 1064-9, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27602967

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV) facial lipoatrophy (FLA) is associated with the use of highly active antiretroviral therapy (HAART) and HIV disease. HIV FLA is primarily characterized by midface (cheeks and temples) volume loss, resulting in a "sunken" and aged appearance. Filler agents for treatment of HIV FLA can provide midface volumization and improve quality-of-life (QOL). A 20 mg/ml hyaluronic acid (HA) filler (Juvéderm Voluma® XC, Allergan plc, Irvine, CA) may provide an immediate, natural appearing facial enhancement outcome in one treatment. We hypothesized that this HA filler for treatment of HIV FLA is safe and efficacious and may help improve patients' QOL.
OBJECTIVE: To provide patient reported outcomes from HA filler for treatment of HIV FLA and suggest recommendations on use of validated QOL outcome measures to assess patient concerns specific to HIV FLA.
METHODS: This was a prospective, open-label, phase I and II study to evaluate patient reported outcomes, in addition to safety and efficacy, of this HA filler for treatment of HIV FLA in 20 subjects at the Sacramento Veterans Affairs Medical Center, Mather, CA (ClinicalTrials.gov NCT02342223). Outcome measures include the Dermatology Life Quality Index (DLQI) and a subject satisfaction questionnaire (SSQ).
RESULTS: Nineteen subjects completed the 12-month follow-up. There was no significant improvement of DLQI score. Subject comments revealed high degree of satisfaction and there were no negative comments on the SSQ.
CONCLUSIONS: In this study, we report that all subjects that completed this study were satisfied and had subjective improvement of their QOL post-treatment. We recommend against use of DLQI in the future as it may not fully encompass the emotional and mental health aspects that may be affected from HIV FLA. We recommend use of the Facial Appearance Inventory (FAI) and FACE-Q in future studies for HA filler treatment of HIV FLA.

J Drugs Dermatol. 2016;15(9):1064-1069.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos/administração & dosagem , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Adulto , Idoso , Seguimentos , Síndrome de Lipodistrofia Associada ao HIV/diagnóstico , Síndrome de Lipodistrofia Associada ao HIV/psicologia , Hospitais de Veteranos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
8.
BMJ Case Rep ; 20162016 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-26917795

RESUMO

Highly active antiretroviral therapy (HAART) is associated with multiple metabolic disorders, including lipodystrophy, dyslipidaemia and insulin resistance. HIV/HAART-associated lipodystrophy syndrome (HALS) is characterised by subcutaneous fat wasting, central fat accumulation and increased risk of diabetes. Thiazolidinediones are considered a promising treatment for HALS, because they improve insulin sensitivity and increase subcutaneous fat mass. In previous studies, pioglitazone increased overall fat mass in patients with HALS but whether fat distribution changes remains unclear. We describe a HALS patient with diabetes treated with pioglitazone. Prior to pioglitazone therapy, he had hollowed cheeks, loss of fat in the extremities and abdominal obesity. 18 months after starting pioglitazone and switching his HAART regimens, T1-weighted MRI showed obvious increases in the subcutaneous fat mass of the neck and upper trunk, but no changes in the cheeks and extremities. Pioglitazone therapy for HALS could increase subcutaneous fat mass in non-lipoatrophic but not in lipoatrophic regions.


Assuntos
Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Gordura Subcutânea/efeitos dos fármacos , Tiazolidinedionas/administração & dosagem , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Distribuição da Gordura Corporal , Síndrome de Lipodistrofia Associada ao HIV/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade , Pioglitazona , Resultado do Tratamento
9.
PLoS One ; 11(1): e0146222, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26789842

RESUMO

OBJECTIVE: This study was designed to explore the efficacy and safety of saroglitazar 4 mg on hypertriglyceridemia in patients with HIV associated lipodystrophy. METHODS: During this 12-week prospective, multi-centric, open-label, single arm exploratory study, 50 patients were enrolled to receive saroglitazar 4 mg orally once daily in the morning before breakfast. The primary efficacy endpoint was the percent change in triglyceride (TG) levels from baseline to Week 6 and Week 12. The secondary efficacy endpoints were assessment of low-density-lipoprotein (LDL), very-low-density-lipoprotein (VLDL), high-density-lipoprotein (HDL), non-HDL cholesterol, total cholesterol, apo-lipoprotein (Apo) A1, Apo B, and C-peptide and fasting insulin for HOMA beta and HOMA IR. Safety assessment was performed during the study. RESULTS: Saroglitazar 4 mg significantly decreased the serum TG levels from baseline at Week 6 (percent change: -40.98; 95% CI: -50.82, -31.15) and Week 12 (percent change -45.11; 95% CI: -52.37, -37.86). Reduction in VLDL cholesterol (percent change: -46.33; 95% CI: -52.89, -39.76) and total cholesterol (percent change: 7.37; 95% CI: 1.96, 12.78) was observed at week 12 from baseline. Saroglitazar increased HDL cholesterol (percent change: 34.56, 95% CI: 22.22, 46.90), Apo A1 (percent change: 33.16; 95% CI: 18.69, 47.63) and Apo B (percent change: 10.55, 95% CI: 2.86, 18.25) levels at week 12 from baseline. Saroglitazar treatment led to increase in the C-peptide (percent change: 59.42, 95% CI: 48.78, 70.06), fasting insulin levels (percent change: 47.10; 95% CI: 38.63, 55.57), HOMA of beta cell function for C-peptide (percent change: 71.67; 95% CI: 39.09, 104.26) and HOMA of insulin resistance for C-peptide (percent change: 58.29, 95% CI: 46.74, 69.83) at week 12 from baseline. Saroglitazar treatment was safe and well tolerated in this study. CONCLUSION: Overall, the observed changes in lipid profile after 12 weeks of saroglitazar treatment were in the direction of improvement in patients with HIV associated lipodystrophy. TRIAL REGISTRATION: Clinical Trial Registry of India Phase II/CTRI/2010/091/000107.


Assuntos
Síndrome de Lipodistrofia Associada ao HIV/sangue , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Hipertrigliceridemia/sangue , Hipertrigliceridemia/tratamento farmacológico , Fenilpropionatos/administração & dosagem , Pirróis/administração & dosagem , Adolescente , Adulto , Idoso , Colesterol/sangue , Feminino , Humanos , Insulina/sangue , Lipoproteínas/sangue , Masculino , Pessoa de Meia-Idade , Fenilpropionatos/efeitos adversos , Estudos Prospectivos , Pirróis/efeitos adversos
10.
PLoS One ; 10(12): e0144789, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26658801

RESUMO

BACKGROUND AND OBJECTIVES: Obesity and HIV-1/HAART-associated lipodystrophy syndrome (HALS) share clinical, pathological and mechanistic features. Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a multifunctional cytokine that plays an important role in obesity and related diseases. We sought to explore the relationship between HALS and circulating levels of soluble (s) TWEAK and its scavenger receptor sCD163. METHODS: This was a cross-sectional multicenter study of 120 HIV-1-infected patients treated with a stable HAART regimen; 56 with overt HALS and 64 without HALS. Epidemiological and clinical variables were determined. Serum levels of sTWEAK and sCD163 levels were measured by ELISA. Results were analyzed with Student's t-test, Mann-Whitney U and χ2 test. Pearson and Spearman correlation were used to estimate the strength of association between variables. RESULTS: Circulating sTWEAK was significantly decreased in HALS patients compared with non-HALS patients (2.81±0.2 vs. 2.94±0.28 pg/mL, p = 0.018). No changes were observed in sCD163 levels in the studied cohorts. On multivariate analysis, a lower log sTWEAK concentration was independently associated with the presence of HALS (OR 0.027, 95% CI 0.001-0.521, p = 0.027). CONCLUSIONS: HALS is associated with decreased sTWEAK levels.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Síndrome de Lipodistrofia Associada ao HIV/sangue , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Fatores de Necrose Tumoral/sangue , Adulto , Antígenos CD/sangue , Antígenos CD/genética , Antígenos de Diferenciação Mielomonocítica/sangue , Antígenos de Diferenciação Mielomonocítica/genética , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , Citocina TWEAK , Feminino , Expressão Gênica , HIV-1/fisiologia , Síndrome de Lipodistrofia Associada ao HIV/diagnóstico , Síndrome de Lipodistrofia Associada ao HIV/genética , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Receptores de Superfície Celular/sangue , Receptores de Superfície Celular/genética , Fatores de Necrose Tumoral/genética
11.
Curr Atheroscler Rep ; 17(12): 73, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26493063

RESUMO

Visceral and hepatic adiposities have been associated with both cardiovascular and liver disease and are of concern in HIV-infected persons in the modern era of combination antiretroviral therapy (ART). The development of therapeutic targets to reduce visceral and hepatic adiposities in HIV-infected persons has been slow, because of early reports that attributed the excess adiposity to specific antiretroviral drugs. Visceral adiposity was initially thought to occur as part of a protease inhibitor-induced "HIV-associated lipodystrophy syndrome." Subsequent studies show that visceral adiposity is likely a result of effective ART, recovery of health, and the normal aging process. Visceral adiposity is an established risk factor for hepatic adiposity. Identifying drug targets for non-alcoholic fatty liver disease is under active investigation. The present review summarizes the recent literature on the pathogenesis of visceral and hepatic adiposities in HIV-infected persons, current therapeutic strategies, and novel interventions in HIV-infected and uninfected persons.


Assuntos
Adiposidade , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Animais , Doenças Cardiovasculares/complicações , Humanos , Fatores de Risco
12.
PLoS One ; 10(10): e0140358, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26457580

RESUMO

BACKGROUND: Tesamorelin, a synthetic analog of human growth hormone-releasing factor, decreases visceral adipose tissue (VAT) in human immunodeficiency virus (HIV)-infected patients with lipodystrophy. OBJECTIVES: 1) To evaluate the utility of patient characteristics and validated disease-risk scores, namely indicator variables for the metabolic syndrome defined by the International Diabetes Federation (MetS-IDF) or the National Cholesterol Education Program (MetS-NCEP) and the Framingham Risk Score (FRS), as predictors of VAT reduction during tesamorelin therapy at 3 and 6 months, and 2) To explore the characteristics of patients who reached a threshold of VAT <140 cm2, a level associated with lower risk of adverse health outcomes, after 6 months of treatment with tesamorelin. METHODS: Data were analyzed from two Phase 3 studies in which HIV-infected patients with excess abdominal fat were randomized in a 2:1 ratio to receive tesamorelin 2 mg (n = 543) or placebo (n = 263) subcutaneously daily for 6 months, using ANOVA and ANCOVA models. RESULTS: Metabolic syndrome (MetS-IDF or MetS-NCEP) and FRS were significantly associated with VAT at baseline. Presence of metabolic syndrome ([MetS-NCEP), triglyceride levels >1.7 mmol/L, and white race had a significant impact on likelihood of response to tesamorelin after 6 months of therapy (interaction p-values 0.054, 0.063, and 0.025, respectively). No predictive factors were identified at 3 months. The odds of a VAT reduction to <140 cm2 for subjects treated with tesamorelin was 3.9 times greater than that of subjects randomized to placebo after controlling for study, gender, baseline body mass index (BMI) and baseline VAT (95% confidence interval [CI] 2.03; 7.44). CONCLUSIONS: Individuals with baseline MetS-NCEP, elevated triglyceride levels, or white race were most likely to experience reductions in VAT after 6 months of tesamorelin treatment. The odds of response of VAT <140 cm2 was 3.9 times greater for tesamorelin-treated patients than that of patients receiving placebo.


Assuntos
Gordura Abdominal/patologia , Hormônio Liberador de Hormônio do Crescimento/análogos & derivados , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu , Feminino , Hormônio Liberador de Hormônio do Crescimento/efeitos adversos , Hormônio Liberador de Hormônio do Crescimento/uso terapêutico , Síndrome de Lipodistrofia Associada ao HIV/sangue , Síndrome de Lipodistrofia Associada ao HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Triglicerídeos/sangue
13.
J Strength Cond Res ; 29(12): 3466-71, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25970490

RESUMO

This study aimed to evaluate the impact of strength training on bone mineral density (BMD) in individuals harboring HIV exhibiting lipodystrophy. The study included 20 subjects (16 men) aged 50.60 ± 6.40 years with reduced BMD, presenting positive serology for HIV, using highly active antiretroviral therapy, and performing no regular practice of physical exercise before being enrolled in the study. Bone mineral density levels were evaluated by dual-energy x-ray absorptiometry in the lumbar spine, femoral neck, and 1/3 radius, before and after 36 sessions (12 weeks) of strength training. Compared with pre-exercise period, the results showed increased BMD in lumbar spine (3.28%; p = 0.012), femoral neck (8.45%; p = 0.044), and 1/3 radius (5.41%; p = 0.035). This is the first study evaluating the impact of strength training in patients living with HIV and exhibiting lipodystrophy, showing an increased BMD in all the regions measured (lumbar spine, femoral neck, and 1/3 radius). This study showed the beneficial impact of the strength training on BMD increase in patients living with HIV as an effective and available approach to improve bone health.


Assuntos
Densidade Óssea , Síndrome de Lipodistrofia Associada ao HIV/fisiopatologia , Treinamento de Resistência , Absorciometria de Fóton , Adulto , Idoso , Feminino , Colo do Fêmur , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)
14.
Dermatology ; 230(4): 367-74, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25870932

RESUMO

OBJECTIVE: This prospective observational study evaluated magnetic resonance imaging (MRI) findings of hyaluronic acid (HA) injections used for the correction of HIV-associated facial lipoatrophy. METHODS: Ten consecutive males underwent subdermal HA injection (mean 1.3 ± 0.6 ml per side) and MRI examinations prior to and then 1, 6 and 12 months after injection. Two radiologists blinded to the clinical data assessed morphologic and quantitative changes. RESULTS: MRI revealed HA deposition in the subdermal and deep fat compartments. A significant HA volume increase was observed 1 month after injection (mean increase 331%, p < 0.0001) as compared to the injected amount. No volume reduction occurred at 12 months (p = 0.9961). The measured bound water content did not change (p > 0.9991), whereas skin thickness and tissue vascularization increased during the first 6 months (p = 0.01). CONCLUSION: Our data show that the cosmetic results of HA injections are caused by water binding in the deep facial fat and by a transient increase in vascularization and skin thickness.


Assuntos
Tecido Adiposo/patologia , Preenchedores Dérmicos/farmacologia , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Ácido Hialurônico/farmacologia , Tecido Adiposo/irrigação sanguínea , Atrofia/tratamento farmacológico , Atrofia/patologia , Técnicas Cosméticas , Preenchedores Dérmicos/química , Preenchedores Dérmicos/farmacocinética , Face , Síndrome de Lipodistrofia Associada ao HIV/patologia , Humanos , Ácido Hialurônico/química , Ácido Hialurônico/farmacocinética , Injeções Subcutâneas , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Pele/irrigação sanguínea , Pele/patologia , Distribuição Tecidual , Água/química
15.
J Endocrinol Invest ; 38(7): 779-84, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25722225

RESUMO

PURPOSE: Combined antiretroviral therapy (cART) for the treatment of HIV-1 infection has been associated with complications, including lipodystrophy. Several interleukins have been implicated in the pathology and physiology of lipodystrophy. The present study aimed to compare the levels of IL-4 and IL-6 in HIV-1 patients under cART with and without, clinically and fat mass ratio defined, lipodystrophy and in four different groups of fat distribution: (1) no lipodystrophy; (2) isolated central fat accumulation; (3) isolated lipoatrophy and (4) mixed forms of lipodystrophy. METHODS: In the present cross-sectional study we evaluated IL-4 and IL-6 levels, insulin resistance and insulin sensitivity indexes in 86 HIV-infected adults under cART. RESULTS: No significant differences in IL-4 and IL-6 levels between the four groups of body composition were observed. Patients with HOMA-IR >4 presented higher levels of IL-6 and lower levels of IL-4, although without statistical significance. No correlation between IL-6, or IL-4, HOMA-IR and quantitative body fat mass distribution was found. CONCLUSION: Although there was a tendency for patients with isolated lipoatrophy and isolated fat accumulation to present higher IL-6 levels, these differences were not statistically significant. No differences were found relating IL-4 levels.


Assuntos
Antirretrovirais/efeitos adversos , Distribuição da Gordura Corporal , Infecções por HIV/tratamento farmacológico , Infecções por HIV/metabolismo , Resistência à Insulina , Interleucina-4/sangue , Interleucina-6/sangue , Adulto , Feminino , Infecções por HIV/sangue , Síndrome de Lipodistrofia Associada ao HIV/sangue , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Síndrome de Lipodistrofia Associada ao HIV/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade
16.
Metabolism ; 64(1): 47-59, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25267014

RESUMO

Leptin is a hormone secreted by adipocytes that regulates energy metabolism via peripheral action on glucose synthesis and utilization as well as through central regulation of food intake. Patients with decreased amounts of fat in their adipose tissue (lipoatrophy) will have low leptin levels, and hypoleptinemic states have been associated with a variety of metabolic dysfunctions. Pronounced complications of insulin resistance, dyslipidemia and fatty liver are observed in patients suffering from congenital or acquired generalized lipodystrophy while somewhat less pronounced abnormalities are associated with human immunodeficiency virus (HIV) and the use of highly active antiretroviral therapy, the so-called HIV-associated lipodystrophy. Previous uncontrolled open-label studies have demonstrated that physiological doses of leptin repletion have corrected many of the metabolic derangements observed in subjects with rare fat maldistribution syndromes such as generalized lipodystrophy. In the much more commonly encountered HIV-associated lipodystrophy, leptin replacement has been shown to decrease central fat mass and to improve insulin sensitivity, dyslipidemia, and glucose levels. The United States Food and Drug Administration has recently granted approval for recombinant leptin therapy for congenital and acquired generalized lipodystrophy, however large, well-designed, placebo-controlled studies are needed to assess long-term efficacy, safety and adverse effects of leptin replacement. In this review, we present the role of leptin in the metabolic complications of congenital and acquired lipodystrophy and discuss current and emerging clinical therapeutic uses of leptin in humans with lipodystrophy.


Assuntos
Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Leptina/metabolismo , Leptina/farmacologia , Lipodistrofia/tratamento farmacológico , Animais , Síndrome de Lipodistrofia Associada ao HIV/metabolismo , Humanos , Lipodistrofia/metabolismo , Doenças Metabólicas/tratamento farmacológico , Doenças Metabólicas/metabolismo
17.
Rev. bras. cir. plást ; 30(2): 250-257, 2015. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1020

RESUMO

Introdução: O tratamento de pacientes portadores da síndrome da imunodeficiência adquirida deve ser integral e se basear no controle da doença e das complicações relacionadas ao uso de medicações antirretrovirais, como a lipodistrofia. Esse estudo tem como objetivo avaliar as principais queixas, os aspectos epidemiológicos e os procedimentos cirúrgicos realizados para corrigir a lipodistrofia em pacientes em uso crônico de antirretrovirais. Método: Estudo retrospectivo, no qual foram coletados dados dos prontuários de 27 pacientes submetidos a 36 procedimentos cirúrgicos relacionados à correção de lipodistrofia no período de março de 2010 a junho de 2014 no serviço de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto. Resultados: A idade média dos pacientes foi 47,2 anos, 22,2% homens e 77,8% mulheres. O tempo médio de uso da terapia antirretroviral (TARV) foi de 12,1 anos. As queixas mais encontradas foram: giba dorsal (44,4%), lipodistrofia abdominal (44,4%) e lipoatrofia glútea (37,04%). Na maioria dos pacientes (70,4%), foi realizada uma cirurgia. Quanto às cirurgias, a lipoaspiração de giba foi realizada em 48,1% dos pacientes, seguida da lipoaspiração de abdome, dorso ou flancos (44,4%) e gluteoplastia (22,2%). Entre todos os 36 procedimentos realizados, apenas dois apresentaram complicações. O tempo médio de seguimento pós-operatório foi de 11,2 meses. Do total, 70,4% dos pacientes mostraram-se satisfeitos após os procedimentos. Conclusões: O sucesso do tratamento cirúrgico da lipodistrofia causada pelo uso da TARV baseia-se na seleção pré-operatória adequada e em seguimento constante e prolongado. A melhoria da autoestima facilita a adesão ao tratamento com antirretrovirais.


Introduction: Treatment of patients with acquired immunodeficiency syndrome should be complete and based on controlling the disease and the complications related to the use of antiretroviral medications, such as lipodystrophy. This study aimed to evaluate the main complaints, epidemiological aspects, and surgical procedures performed for lipodystrophy correction among patients receiving long-term antiretroviral therapy. Method: In this retrospective study, data were collected from the medical records of 27 patients who underwent 36 surgical procedures associated with lipodystrophy correction, from March 2010 to June 2014, at the Plastic Surgery Service of the Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto. Results: The average age of the patients was 47.2 years; 22.2% were men and 77.8% were women. The average duration of antiretroviral therapy (HAAR ) was 12.1 years. The most frequent complaints were dorsal hump (44.4%), abdominal lipodystrophy (44.4%), and gluteal lipoatrophy (37.04%). The majority of patients (70.4%) had undergone surgery . The most common type of surgery performed was hump liposuction (carried out in 48.1% of the patients), followed by abdominal, back, or flank liposuction (44.4%) and gluteoplasty (22.2%). Among all 36 procedures performed, only 2 resulted in complications. The average postoperative follow-up period was 11.2 months. In total, 70.4% of patients were satisfied with the results of their procedure. Conclusions: The success of surgical treatment of HAARinduced lipodystrophy is based on proper preoperative selection as well as constant and prolonged follow-up. Improved selfesteem facilitates the adherence to antiretroviral drug treatment.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Lipectomia , Registros Médicos , Epidemiologia Descritiva , Estudos Retrospectivos , Síndrome de Imunodeficiência Adquirida , Procedimentos Cirúrgicos Reconstrutivos , Terapia Antirretroviral de Alta Atividade , Síndrome de Lipodistrofia Associada ao HIV , Antirretrovirais , Estudo Observacional , Lipodistrofia , Lipectomia/métodos , Registros Médicos/normas , Síndrome de Imunodeficiência Adquirida/cirurgia , Síndrome de Imunodeficiência Adquirida/patologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia Antirretroviral de Alta Atividade/métodos , Síndrome de Lipodistrofia Associada ao HIV/cirurgia , Síndrome de Lipodistrofia Associada ao HIV/patologia , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Antirretrovirais/uso terapêutico , Lipodistrofia/tratamento farmacológico , Lipodistrofia/terapia
18.
BMC Infect Dis ; 14: 474, 2014 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-25178390

RESUMO

BACKGROUND: Facial lipoatrophy is a frequently reported condition associated with use of antiretroviral (ARV) drugs. Poly-L-lactic acid (PLLA) acid has been used to correct facial lipoatrophy in people with HIV since 2004 both in Europe and the United States. The objective of this study was to establish, in real life conditions and in a large sample, the safety of PLLA (New Fill®, Valeant US, Sinclair Pharma Paris, France) to correct facial lipoatrophy among HIV-positive patients. METHODS: A longitudinal study was conducted between 2005 and 2008 in France. Data from 4,112 treatment courses (n = 4,112 patients) and 15,665 injections sessions (1 to 5 injection sessions per treatment course) were gathered by 200 physicians trained in the use of PLLA. RESULTS: The average age of patients (88.3% males) treated for lipoatrophy was 47.1 ± 8.1 years (Mean ± SD); 91.2% of patients had been receiving ARV treatment for 10.9 (±4.2) years; CD4 T-cell count was 535 ± 266 cells/mm3. The duration of facial lipoatrophy was 5 ± 2.8 years and the severity was such that 47.3% of patients required five injection sessions of PLLA and 81.9% of the sessions required two vials of the preparation. The final visit, scheduled two months after the last injection session, was attended by 66.0% of patients (n = 2,713). 48 treatment courses (2.8%) were discontinued due to adverse events (AEs). The overall incidence of AEs per course was 18.8%. Immediate AEs, bleeding (3.4%), bruising (2.3%), pain (2.0%), redness at injection site (1.6%), and swelling of the face (0.7%), occurred in 15.4% of courses and 7.0% of sessions (usually during the first session). Non-immediate AEs, mainly nodules (5.7%), inflammation (0.7%), granuloma (0.3%), discolouration (0.2%), and skin hypertrophy (0.1%), occurred in 6.7% of courses. Non-immediate AEs occurred within a time ranging from 21 days (inflammation) to 101 days (granuloma) and all but three of the 13 cases of granuloma resolved. Product efficacy was rated satisfactory by 95% of the patients and physicians. CONCLUSIONS: This study demonstrated, in real-life conditions and on a large sample, that PLLA injections were feasible, efficient, and safe when performed by trained physicians.


Assuntos
Celulose/uso terapêutico , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Ácido Láctico/uso terapêutico , Manitol/uso terapêutico , Adulto , Contagem de Linfócito CD4 , Face , Feminino , França , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Poliésteres , Polímeros/uso terapêutico , Estados Unidos
19.
Expert Opin Pharmacother ; 15(12): 1749-60, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24934336

RESUMO

INTRODUCTION: With the introduction of combination antiretroviral therapy (ART) for HIV infection in the mid-1990s, descriptions of morphological changes and metabolic disturbances in treated patients began to emerge. HIV-1/highly active ART-associated lipodystrophy syndrome (HALS) involves metabolic abnormalities and diverse forms of anomalous fat distribution. The current review focuses on the pathophysiological basis and the clinical evidence for the use of several medical strategies in the management of HALS. AREAS COVERED: We have covered the most relevant studies related to the pharmacological strategies in the treatment of HALS, with attention to the current and novel antiretroviral agents. EXPERT OPINION: The most commonly used strategies for HALS reversion have included modification of host-dependent factors, including those related to HIV-1 infection and those associated with ART. Preventive and medical strategies have been associated with moderate success. The only intervention that offers an immediate aesthetical improvement for patients with HALS so far has been plastic surgery.


Assuntos
Antirretrovirais/uso terapêutico , HIV-1/efeitos dos fármacos , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Adiposidade/efeitos dos fármacos , Animais , Antirretrovirais/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , HIV-1/isolamento & purificação , Síndrome de Lipodistrofia Associada ao HIV/diagnóstico , Síndrome de Lipodistrofia Associada ao HIV/etiologia , Síndrome de Lipodistrofia Associada ao HIV/fisiopatologia , Hormônios/uso terapêutico , Humanos
20.
J Pediatr Endocrinol Metab ; 27(11-12): 1247-51, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24859501

RESUMO

Abstract We report a case of a 17-year-old girl with a history of congenital human immunodeficiency virus (HIV) infection and lipodystrophy secondary to highly active antiretroviral therapy (HAART). She developed severe worsening of preexisting hypertriglyceridemia after treatment with oral contraceptive pills (OCP) for polycystic ovary syndrome. Her hypertriglyceridemia improved upon OCP discontinuation. Although it is known that estrogen combined with progestins have a negative effect on triglycerides and high-density lipoprotein (HDL) cholesterol levels, to our knowledge the association of HAART-related lipodystrophy and severe hypertriglyceridemia after OCP use has not been reported in the literature. We recommend avoiding the use of OCPs in patients with lipodystrophy due to the increased risk of worsening hypertriglyceridemia.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Anticoncepcionais Orais/efeitos adversos , Síndrome de Lipodistrofia Associada ao HIV/tratamento farmacológico , Hipertrigliceridemia/induzido quimicamente , Síndrome do Ovário Policístico/tratamento farmacológico , Adolescente , Feminino , Síndrome de Lipodistrofia Associada ao HIV/induzido quimicamente , Humanos , Lipoproteínas HDL/metabolismo , Síndrome do Ovário Policístico/complicações , Prognóstico , Literatura de Revisão como Assunto , Triglicerídeos/metabolismo
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