Discordance Between Body Mass Index and Anthropometric Measurements Among Hiv-1-Infected Patients on Antiretroviral Therapy and With Lipoatrophy/Lipohypertrophy Syndrome

Abstract

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.

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

“…The prevalence of clinical dystrophy in this study was similar to the one found in another national study of similar size 23 . In an article by Soares et al 26 with 227 PLWHA, the prevalence of lipodystrophy found through subjective method was 40%, the highest prevalence was observed among women (44 versus 38.8%), as observed in our study (56.5 versus 48.6%). On the other hand, Diehl et al 13 found a higher prevalence of lipodystrophy among men (68 versus 46%), as observed here by the FMR index.…”

Prevalência de excesso de peso em pessoas que vivem com HIV: uma revisão sistemática

“…O estudo de população predominantemente masculina (152 homens e 75 mulheres) identificou autorrelato de síndrome lipodistrófica por 33% das mulheres e 59% entre os homens, além de 57,7% de risco de doença cardiovascular e 47,6% de excesso de peso. 9 Entretanto, foram utilizados peso e altura relatados pelos pacientes, o que pode ter subestimado os resultados.…”

“…Apenas um estudo comparou grupo HIV+ com uso de TARV, com grupo HIV+ sem uso de TARV. 9 Na Tabela 2 é possível observar a prevalência de excesso de peso, definida como somatório do sobrepeso e obesidade, verificando que variou entre 25% até 48,3%. Estes dados já trazem a prevalência próxima dos estudos para população geral, como por exemplo, no Brasil, os dados populacionais descritos pelo Vigitel (Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico) em 2014 descrevem prevalência de excesso de peso de 52,5%.…”

“…Estes dados já trazem a prevalência próxima dos estudos para população geral, como por exemplo, no Brasil, os dados populacionais descritos pelo Vigitel (Vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico) em 2014 descrevem prevalência de excesso de peso de 52,5%. 16 Estudo realizado por Soares et al 9 avaliou 227 participantes divididos em três grupos: grupo 1 = 92 HIV+ em uso de TARV e com autorrelato de lipodistrofia. Grupo 2 = 70 HIV+ em uso de TARV sem autorrelato de lipodistrofia, e grupo 3 = 65 HIV+ sem uso de TARV.…”

“…Soares et al 9 Senna et al 10 Núñez-Rocha et al 11 Kroll et al 12 Mariz et al 13 Duran et al O excesso de peso foi citado e discutido em todos os artigos, e a prevalência variou entre 25% a 48,3%. Segundo os estudos descritos no presente trabalho, a prevalência de excesso de peso pode estar associada à idade, diabetes,¹³ a baixa qualidade da dieta, 14 hipertensão, tabagismo, baixo nível educacional 10 e maior tempo de diagnóstico.¹¹…”