Redistribuição de gordura corporal e alterações no metabolismo de lipídeos e glicose em pessoas vivendo com HIV/AIDS

Abstract

Introduction:The HIV lipodystrophy syndrome is characterized by changes in metabolism, and body composition that increase cardiovascular risk of people living with HIV/AIDS (PLWHA) using highly active antiretroviral therapy (HAART). Objective: To assess the prevalence of lipodystrophy and changes in lipid and glucose metabolism in PLWHA in use of HAART. Methods: For the anthropometric evaluation we measured weight, height and abdominal circumference (AC). For the lipodystrophy evaluation we conducted physical examination (subjective) and the (objective) examination of absorptiometry with X-ray dual energy (DEXA) by fat mass ratio (FMR). We also conducted lipid profile tests and fasting glucose and used the criteria suggested by The National Cholesterol Education Program III for metabolic disorders classification. Results: The final sample consisted of 262 patients with a mean age of 44.3 ± 10.2 years. Lipodystrophy, according to the physical examination, was present in 47.7% (95%CI 41.7 -53.8) of patients, while the prevalence using FMR (DEXA) was 40.8% (95%CI 33.1 -48.5). Most (53.0%; 95%CI 47.0 -59.1) of the patients showed increased abdominal adiposity according to AC. The most prevalent metabolic alterations were reduced HDL (67.6%; 95%CI 61.9 -73.2) and hypertriglyceridemia (55.7%; 95%CI 49.7 -61.7). Conclusion: The high prevalence of lipodystrophy and changes in lipid and glucose metabolism show the importance of early intervention in this group of patients to prevent cardiovascular complications.

Reduction of relative handgrip strength and cardiometabolic risk in individuals with HIV/AIDS

“…Regarding the anthropometric alterations, the prevalence of overweight and increased WC in the present study were lower than those identified in a study by Beraldo et al 14 . in 262 individuals living with HIV/AIDS (51% and 53%, respectively).…”

Plasma levels of lipopolysaccharide correlate with insulin resistance in HIV patients

“…As previously demonstrated HIV patients on HAART presented dyslipidemia characterized by high triglyceride levels and reduced HDL-cholesterol levels [ 49 ]. This result is by previous data that showed that in patients with HIV in use of HAART the most prevalent metabolic alterations were reduced HDL-cholesterol and hypertriglyceridemia [ 4 ]. The association of dyslipidemia with high levels of LPS may contribute to increasing the cardiovascular risk in HIV patients on HAART.…”

“…Over the past 20 years, the introduction of antiretroviral therapy has increased the life expectancy of HIV patients, but it also introduced complicating diseases such as cardiovascular events, renal disease, osteoporosis and metabolic alterations [ 1 – 3 ]. Previous data showed that in patients with HIV in use of HAART the most prevalent metabolic alterations were reduced HDL-cholesterol and hypertriglyceridemia [ 4 ]. Among the metabolic complications encountered, insulin resistance is a central pathophysiological condition that can contribute to the development of diabetes and cardiovascular events [ 5 – 7 ].…”

Influence of the duration of antiretroviral use on insulin resistance among people living with HIV with lipodystrophy

“…Insulin resistance is also shown to increase, whose effects range from alterations in glucose metabolism to the development of type-2 diabetes mellitus, as reported in the literature 8,20 .…”

“…Lipohypertrophy, or lipomatosis, can occur in more than one region simultaneously and corresponds to the increase in central abdominal fat tissue and in the cervical back, gynecomastia, and enlarged breasts among women. The etiology of lipodystrophy in treated HIV infection is multifactorial 7,8,9 .…”