Resposta de fase aguda, subnutrição e estado nutricional do ferro em adultos com AIDS

Abstract

Resumo Foram comparados o estado nutricional e parâmetros do metabolismo do ferro de adultos HIV-positivos, com ou sem resposta de fase aguda (RFA). Adultos HIV-positivos (n = 29) submeteram-se a antropometria, recordatório alimentar e determinação sérica de albumina, proteína C reativa (PCR), ferritina e capacidade total de ligação do ferro (CTLF), além de creatinina urinária. Infecção mais PCR > 7mg/dl foram critérios de positividade da RFA. Índice de massa corporal (IMC < 18,5kg/m 2 ) e índice creatinina-altura (ICA < 70%) definiram subnutrição. Subnutrição (77,8 vs 40%) e tuberculose pulmonar (44,4 vs 9,5%) foram mais freqüentes nos pacientes RFA-positivos, que também apresentaram menores níveis de albumina (3,7 ± 0,9 vs 4,3 ± 0,9g/dl), CTLF (165,8 ± 110,7 vs 265,9 ± 74,6mg/dl) e hemoglobina (10,5± 1,8 vs 12,6 ± 2,3g/dl). A ingestão de ferro foi adequada e similar entre RFA-positivos e RFA-negativos, o mesmo ocorrendo, respectivamente, quanto à ferritina sérica (mediana; variação, 568; 45,3-1814 vs 246; 18,4-1577ng/ml). Pacientes HIV-positivos com resposta de fase aguda são nutricionalmente mais comprometidos e têm anemia que parece não depender da ingestão recente de ferro. Palavras-chaves: Resposta de fase aguda. Ferro. AIDS. Estado nutricional. Subnutrição protéico-energética.Abstract Nutritional status and some iron metabolism parameters of acute phase response (APR) positive and APR-negative AIDS patients were studied. Twenty-nine AIDS patients were submitted to 24h food intake recall, anthropometry, and albumin, C-reactive protein (CRP), hemoglobin, ferritin, and total iron binding capacity (TIBC) measurements. Infection plus serum CRP > 7mg/dl were criteria for APR presence. Protein-energy malnutrition (PEM) was ascertained by body mass index (BMI) lower than 18.5kg/m 2 and height-creatinine index (HCI < 70%). PEM (77.8 vs 40%) and pulmonary tuberculosis (44.4 vs 9.5%) were more frequent in APR-positive patients, which also had lower serum albumin (3.7 ± 0.9 vs 4.3 ± 0.9g/dl), TIBC (165.8 ± 110.7 vs 265.9 ± 74.6mg/dl) and blood hemoglobin (10.5 ± 1.8 vs 12.6 ± 2.3g/dl). Iron intake was similar between groups; however, serum ferritin levels (median, range) were higher among APR-positive (568, 45.3-1814 vs 246, 18.4-1577ng/ml) patients. HIV-positive adults with systemic response to invading pathogens showed worse nutritional status than those APR-negative. In APR-positive AIDS patients, anemia appears to be unrelated to recent iron intake.

Body mass index in individuals with HIV infection and factors associated with thinness and overweight/obesity

“…Low serum albumin has been used as an indicator of malnutrition when assessing nutritional status 38 . In this study, among patients who had serum albumin (1,741 -86.3%), the vast majority (94.8%) had serum albumin levels ≥ 3.5mg/ dL, thus differing from results reported by other authors 39,40,41 .…”

“…Understanding the association between anemia and thinness is relatively easy, since the association between protein-calorie malnutrition and anemia in HIV-positive individuals is already well established in the literature 39,43,44 . However, it would appear to be more difficult to understand the association between anemia and overweight/ obesity in this same population.…”

Biomarkers in Immune Reconstitution Inflammatory Syndrome (IRIS) among People Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)

“…The other cause of reduction in hemoglobin concentration is the shortage of micronutrients like deficiency of iron, vitamin B12 and B9 required for haematopoiesis [19]. Although, patients with HIV/AIDS are nutritionally compromised and have anemia, it does not seem to depend on the recent intake of iron [23]. This study shows there is an association of low albumin levels among HIV patients [14].…”

“…Significant (P<0.0001) viral load suppression showed among HAART initiated male patients with IRIS when compared with naïve female patients without IRIS. BMI (18)(19)(20)(21)(22)(23)(24)(25)(26), hemoglobin level below 8 g/ dl, TLC, serum albumin level below 5 g/dl, HDL level below 61 mg/dl, ESR level, CRP value and absolute eosinophil count showed significant (P<0.05) difference between HAART naïve and on HAART male patients with IRIS as shown in Table 2.…”

Comment on the clinical note: Acute necrotizing esophagitis in an unstable patient.

“…Remarkable laboratory data were hypoalbuminemia, accentuated anemia and leukocytosis with neutrophilia, in addition to hyponatremia and high platelet count [1][2][3][4] . These changes can be found in acute phase response (APR) and protein-energy malnutrition (PEM) 6,7 . He received gastric protection, total parenteral nutrition and intravenous fluconazole.…”