Bone mineral density in HIV-infected women taking antiretroviral therapy: a systematic review Densidade mineral óssea em mulheres infectadas pelo vírus do HIV e tratadas com terapia antirretroviral: uma revisão sistemática

Summary There is a high prevalence of osteoporosis in HIV-infected patients. Initially described in HIVpositive men, studies have also demonstrated a high prevalence of osteoporosis in HIV-infected women. It would appear that antiretroviral therapy (ART) plays an important role in the pathogenesis of osteoporosis in HIV-infected patients, although little is known about its importance in relation to osteoporosis and fractures in HIV-positive women. The aim of this systematic review was to evaluate the frequency of bone loss, bone mineral density (BMD) and fractures in HIVpositive women taking ART or protease inhibitors (PI). After screening 597 citations from the databases of PubMed, EMBASE and Lilacs, five studies were selected for the review. A difference was demonstrated of over 3% in the BMD at the femoral neck of HIV-positive women taking PI/ ART. No difference was registered in the BMD at the lumbar spine between users and non-users of PI/ART. The lack of studies has made it impossible to reach any conclusion regarding the occurrence of fractures. Arq Bras Endocrinol Metab. 2010;54(2):133-42 Keywords HIV; osteoporosis; fractures, bone; bone density; highly active antiretroviral therapy; systematic review Sumário A prevalência de osteoporose é elevada em indivíduos infectados pelo HIV. Inicialmente descrita em homens HIV-positivos, estudos demonstraram alta prevalência de osteoporose também em mulheres HIV-positivas. A terapia antirretroviral parece exercer papel importante na patogênese da osteoporose dos indivíduos com HIV. Pouco se sabe sobre sua importância para a osteoporose e fraturas nas mulheres HIV-positivas. Esta revisão objetivou avaliar a frequência de perda de massa óssea, densidade mineral óssea (DMO) e fraturas em mulheres HIV-positivas em uso de terapia antirretroviral (TARV) ou inibidores de protease (IP). Após busca nos bancos de dados PubMed, EMBASE e Lilacs, de 597 citações, cinco estudos permaneceram na revisão. Demonstrou-se haver uma diferença superior a 3% na DMO no colo do fêmur de mulheres HIV-positivas em uso de IP/TARV. Não se evidenciou diferença na DMO da coluna lombar entre usuárias e não usuárias de IP/TARV. A escassez de estudos impossibilitou qualquer conclusão sobre a ocorrência de fraturas. Arq Bras Endocrinol Metab. 2010;54(2):133-4

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

A cross-sectional study was conducted using body mass index (BMI) to estimate the prevalence of thinness and overweight/obesity and associated factors in 2,018 individuals with HIV/AIDS attending health services referral centers. The dependent variable was classified as thinness, overweight/obesity and eutrophy. Multinomial logistic regression analyses were performed considering eutrophy as the reference level. The prevalence of thinness was 8.8% and of overweight/obesity, 32.1%. The variables associated with thinness were anemia and CD4 cell count < 200mm³. The variables associated with risk of overweight/obesity were age &gt; 40 years and diabetes, and the variables identified as decreasing likelihood of overweight/obesity were having no long-term partner, smoking, presence of an opportunistic disease, anemia, and albumin levels < 3.5mg/dL. The main nutritional problem observed in this population was overweight and obesity, which were much more prevalent than thinness. Older individuals with diabetes should be targeted for nutritional interventions and lifestyle changes