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

Micronutrient deficiency is common in patients with HIV/AIDS, usually caused by mal-absorption and/or drug interactions. 25-hydroxyvitamin D is of fundamental importance for the homeostasis of musculoskeletal health. The current study aimed to evaluate the nutritional status of HIV-infected subjects in order to make their nutritional diagnoses, including their vitamin D blood levels, and to estimate their consumption of vitamin D. The study included 98 HIV-1-infected subjects, followed at University of São Paulo Medical School - HC-FMUSP. We performed a nutritional evaluation, along with the determination of patients’ serum 25-hydroxyvitamin D and calcium concentration, biochemical analyses, and an anthropometric assessment. In the medical interview a 24-hour food recall was used (R24) to estimate daily calorie intake, macronutrients, calcium, and vitamin D. A high level of vitamin D deficiency was observed in our patients: 83.4% of them had levels below 30 ng/ml; they also presented an increased risk of cardiovascular disease, along with a high consumption of dietary fat. Factors related to the virus itself and to the use of antiretroviral drugs may have contributed for the low vitamin D levels seen in our HIV-1-infected patients.

Dear Editor, C D4 + cell counts are used to determine risk for HIV disease progression, eligibility for antiretroviral therapy (ART), and immunologic response to ART. A recent Brazilian study suggested that CD4 cell counts are declining more rapidly among recently infected patients than in the pre-combination ART era.1 Rates of CD4 cell decline were compared in a well-characterized clinical cohort from the Hospital das Clinicas (HCFMUSP) in Sã o Paulo, Brazil, in patients diagnosed in the pre-ART era ( < 1998) and those diagnosed after ART became widely available in Brazil ( ‡ 1998). 2,3We examined 81 ART-naive patients at HCFMUSP with known dates of HIV diagnosis between 1988 and 2012 who presented with ‡ 500 CD4 cells/lL. Our primary outcome variable was time from cohort entry until the date of first CD4 count £ 350 cells/lL or of first clinical stage 3 or 4 presentations (WHO). Predictor variables included gender, age, transmission category, CD4 cell count at diagnosis, years of HIV follow up since diagnosis, and chemokine co-receptor type (CXCR4 or CCR5). We dichotomized year of diagnosis into < 1998 and ‡ 1998. We calculated median survival from baseline and 95% confidence intervals (CI) using the Kaplan-Meier method and tested for equality of survivor functions using the log rank statistic. We used the Cox proportional regression model to estimate the hazard ratio (HR) of the association between the predictor variables and outcome (CD4 count £ 350 cells/lL). We also fitted generalized estimating equations (GEE) to build a linear model considering the within-individual correlation structure of repeated CD4 and using the robust variance estimator method. We stratified the GEE model for < 1998 and ‡ 1998 and report the crude and adjusted regression coefficients as rates of CD4 change over time.Out of 81 eligible cases; 32 entered care £ 1998 and 49 afterwards. There were no differences between the groups in age, gender, transmission category, baseline CD4 count, baseline plasma viral load, length of time followed, or CXCR4 tropism. There was a statistically significant association between the period of diagnosis and time to T CD4 + cells decline to £ 350 cells/mm 3 (log rank p < 0.001). Before 1998, the mean time to a CD4 count of 350 cells/lL was 2.43 (95% CI 1.70-3.15) years and from 1998 and later 7.03 (95% CI 5.63-8.42) years (Fig. 1). This adjusted hazard ratio was 0.17 (95% CI 0.08-0.32), corresponding to a decline of 56.68 cells/lL/ year before 1998 and 49.74 cells/lL/year in 1998 and later. Having CXCR4 tropic HIV (HR, 3.1, 95% CI, 1.2-7.8) was statistically associated with progression to CD4 count £ 350 cells/lL. Despite the clinical impression that treatmentnaïve patients are progressing more rapidly in the ART era, we found that CD4 cell counts were, in fact, declining less rapidly in 1998 and later than before 1998. We also found that CXCR4 tropic viruses were associated with faster progression disease, as have other authors, 1,4 but the differential presence of CXCR4 tropic viruses did not explai...

The polymorphism of IL28B was described as important in the pathogenesis of infections caused by some viruses. The aim of this research was to evaluate whether IL28B gene polymorphisms (SNP rs8099917 and SNP rs12979860) were associated with HAM/TSP. The study included 144 subjects were classified according to their neurological status in two groups: Group I (60 asymptomatic HTLV-1 carriers) and Group II (84 HAM/TSP patients). Blood samples were collected, and PBMC separated by Ficoll density gradient centrifugation. DNA was extracted using a commercial kit, and the DNA was stored at -80°C for later analysis. After this, the proviral load was quantified, and the rs8099917 and rs12979860 SNPs in the region of IL28B-gene were analyzed by StepOnePlus Real-time PCR System. A multivariate model analysis, including gender, age, and HTLV-1 DNA proviral load, showed that IL28B polymorphism SNP rs12979860 was not independently associated with HAM/TSP outcome. In contrast, the SNP rs8099917 allele GG was independently associated with HAM/TSP outcome (OR=6.25; IC95%=1.22-32.00). Persons with SNP rs8099917 genotype GG may present a distinct immune response against HTLV-1 infection. So, it seems reasonable to suggest that a search for IL28B polymorphisms should be performed for all HTLV-1-infected subjects in order to monitor their risk for disease development; however, since this is the first description of this finding in the literature, we should first replicate this study with more HTLV-1-infected persons to strengthen the evidence already provided by our results.

Sandra Maria Matta which was incorrectly given as Sandra da Matta. This has now been corrected in both the PDF and HTML versions of the Article. In addition, there was a typographical error in the spelling of the author Tatiane Assone which was incorrectly given as Tatiane Assone Assone in the HTML version of this Article. This has now been corrected.

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